It’s called the milking maneuver.
A doctor will set a patient’s arm at a 90 degree angle, bent at the elbow, and then pull the thumb backwards.
It’s intended to test whether damage has been done to the ulnar collateral ligament (UCL).
When it was performed by Bills team doctor Leslie Bisson on Josh Allen Sunday, it produced a positive result.
In this case, “positive” doesn’t mean anything positive at all.
“That (test) puts stretch across the inside of the elbow. If (a patient) has had a traumatic injury, that will be pretty uncomfortable,” said Dr. Michael Maloney. “Unfortunately, it’s pretty clear that Josh had some kind of event because he didn’t seem to tolerate it or like it very much.”
Maloney is the Division Chief for the U of R Orthopedics and a specialist in shoulder and elbow injuries. He did a fellowship with Dr. Frank Jobe who pioneered a groundbreaking procedure to repair fully torn UCL’s. The sports world knows it as “Tommy John” surgery.
“When we see that type of expression when we’re evaluating an athlete, the concern is very high that there’s an injury to that ulnar collateral ligament,” Maloney said.
UCL injuries are something mostly seen in baseball with pitchers who torque and strain and stretch their arm to the max on almost every throw.
NFL quarterbacks don’t have to throw every pass at 100 miles per hour, but there are still other ways to cause a UCL injury.
Maloney says he does see gymnasts and wrestlers hurt their UCL because of the many weight bearing activities they do with the upper body. He also has treated soccer players with UCL injuries when they hold their hand up with the elbow bent and have a ball kicked directly into their palm.
After Allen hit Kelvin Benjamin for a 39 yard connection, he was hit on the left side by Jadaveon Clowney. That shot pushed him into Whitney Mercilus on the opposite side. Mercilus put his head down and hit Allen directly on the outside of the elbow. The arm was bent beyond straight in a way similar to the soccer example above. That, likely, is where the injury occurred.
Maloney says MRI scans are usually one of the first tests performed to determine the severity of the injury. The Bills reportedly sent those scans to Dr. James Andrews for a second opinion, something Maloney said “makes sense” because of Andrews’ well known expertise in the field.
The UCL is the primary stabilizer on the top of the elbow joint. It literally holds the elbow together.
“If someone who throws at that level has sustained a traumatic injury to the ulnar collateral ligament, when they go to throw and replicate that motion, we say the elbow opens up,” Maloney said. “That causes pain. They release the ball at different time points. They lose their velocity. They lose their accuracy or control.”
While “Tommy John” surgery is the most well known way to fix a UCL injury, the field has developed many other less invasive treatment protocols.
Platelet rich plasma therapy can be used to treat smaller tears or stretching of the UCL. Yankees pitcher Masahiro Tanaka has successfully used this technique. Maloney says he’s employed it in Rochester.
If Tommy John surgery is necessary, it would require a 12-18 month rehab, but that does not seem to be the outlook thus far for Allen.
The Bills will next speak to the media about Allen Wednesday morning at 11:20 during Sean McDermott’s weekly press conference.