medial (ulnar) collateral ligament injury
Last reviewed 05/2023
Elbow ulnar collateral ligament insufficiency is commonly seen in sports participants involved in overarm-throwing sports such as cricket, baseball and tennis
- patients present with medial elbow pain
- condition is usually chronic and there may be a history of long-term deterioration in the ability to throw
- trauma and elbow dislocation injuries may result in acute damage to the ulnar ligament
- examination reveals medial elbow tenderness, approximately 2 cm distal to
the medial epicondyle, with or without swelling
- pain may be reproduced by asking the patient to make a clenched fist or by placing the elbow in a valgus stress in 25º of flexion (elbow abduction stress test)
- affected side should be compared with the contralateral elbow for laxity
Investigation
- diagnosis can be made clinically
- x-ray is useful in excluding other causes of elbow pain (osteoarthritis, avulsion fractures, loose bodies)
- MRI is the investigation of choice
Management
- acute injuries should be referred for surgical intervention
- chronic injuries should be referred for physiotherapy
- patient should stop all throwing or exacerbating factors until pain-free
- surgical referral should be considered in chronic injuries after failed physiotherapy with appropriate rest or if the elbow is unstable
Notes:
- ulnar ligament is composed of three bands: anterior, posterior and transverse. The anterior band arises from the medial epicondyle and inserts on the proximal ulna.
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