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Ulnar Collateral Ligament Injury Workup

  • Author: Robert F Kacprowicz, MD, FAAEM; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Apr 14, 2016

Laboratory Studies

See the list below:

  • Laboratory studies are not indicated during the workup of UCL injuries.

Imaging Studies

See the list below:

  • Radiography
    • Findings from routine radiography can occasionally be diagnostic if an avulsion fragment is seen, and in a minority of patients, this study can also reveal secondary findings that are suggestive of UCL injury, such as ossification of the ligament. Plain radiographs are also helpful to rule out other causes of elbow pain, such as epitrochlear osteophytes, epicondylar fractures, posterior olecranon fossa loose bodies, ligamentous calcification, or capitellar lesions.[7]
    • Manual or instrumented valgus stress radiography can be used to document increased joint opening and ligamentous laxity. Significant asymmetry may be observed in traumatic elbow injuries such as dislocations, whereas laxity in a throwing athlete may not be so obvious, with only a very subtle asymmetry.
    • Gravity stress radiography—with the patient supine, the shoulder in maximal external rotation, and the weight of the forearm resisted by the UCL—may also be helpful.[8]
  • Plain arthrography: This imaging modality is not indicated because dye leak has been shown to be inconsistent in cases of chronic laxity, and only an acute event may be anticipated to exhibit a positive finding.
  • Magnetic resonance imaging (MRI): Plain MRI is a useful study; however, because of the relatively small size of the UCL, the overall sensitivity of MRI is 57-79%[9]
  • MR arthrography: This is the most useful imaging modality, with a sensitivity of 97% for UCL injury, and can provide detailed definition of the UCL and associated injuries.[10] Partial-thickness tears can be differentiated from complete tears with MR arthrography. Partial tears demonstrate high signal intensity in the ligament and may show disruption of some fibers, and full-thickness tears are often seen either in the middle of the UCL or at either the distal attachment on the coronoid or at the origin at the medial epicondyle.[11]
  • Ultrasonography: This modality allows for rapid evaluation of the UCL. A ruptured UCL on an ultrasound appears as a discontinuity of the ligament with fluid in the gap between ends or as nonvisualization of the ligament. Sprains appear as thickening, decreased echogenicity of the ligament, and/or edema when compared with the normal ligament.[12]
  • Computed tomography scanning (CT) with intra-articular contrast: This technique has been studied in small numbers of patients. CT scanning with intra-articular contrast appears to be highly sensitive and specific for both acute and chronic injuries,[9] but more data are needed before widespread use can be recommended.


See the list below:

  • Arthroscopy is believed by some authors to be the most specific diagnostic procedure because it allows visualization of the medial compartment while valgus stress is applied; however, clinical suspicion of a UCL injury via a good history and physical examination is probably the most reliable in making the diagnosis.
Contributor Information and Disclosures

Robert F Kacprowicz, MD, FAAEM Private Practice

Robert F Kacprowicz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.


Eric Chumbley, MD Consulting Staff, Department of Sports Medicine, Trover Clinic

Eric Chumbley, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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