Ulnar Collateral Ligament Injury Workup
- Author: Robert F Kacprowicz, MD, FAAEM; Chief Editor: Sherwin SW Ho, MD more...
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- Laboratory studies are not indicated during the workup of UCL injuries.
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- 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.
- 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.
- 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%
- 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. 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.
- 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.
- 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, but more data are needed before widespread use can be recommended.
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- 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.
Hechtman KS, Tjin-A-Tsoi EW, Zvijac JE, Uribe JW, Latta LL. Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow. Am J Sports Med. 1998 Sep-Oct. 26(5):620-4. [Medline].
Lee ML, Rosenwasser MP. Chronic elbow instability. Orthop Clin North Am. 1999 Jan. 30(1):81-9. [Medline].
Maloney MD, Mohr KJ, el Attrache NS. Elbow injuries in the throwing athlete. Difficult diagnoses and surgical complications. Clin Sports Med. 1999 Oct. 18(4):795-809. [Medline].
Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995 Mar-Apr. 23(2):233-9. [Medline].
Bushnell BD, Anz AW, Noonan TJ, Torry MR, Hawkins RJ. Association of maximum pitch velocity and elbow injury in professional baseball pitchers. Am J Sports Med. 2010 Jan 21. epub ahead of print. [Medline].
DeFroda SF, Kriz PK, Hall AM, Zurakowski D, Fadale PD. Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players: A Retrospective Study From 2007 to 2014. Orthop J Sports Med. 2016 Feb. 4 (2):2325967115627126. [Medline].
Safran MR. Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med. 2004 Oct. 23(4):643-63, x. [Medline].
Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med. 1994 Jan-Feb. 22(1):26-31; discussion 32. [Medline].
Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000 Jan-Feb. 28(1):16-23. [Medline].
Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992 Jan. 74(1):67-83. [Medline].
Hariri S, Safran MR. Ulnar collateral ligament injury in the overhead athlete. Clin Sports Med. 2010 Oct. 29(4):619-44. [Medline].
Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013 Jul. 41(7):1689-94. [Medline].
Bowers AL, Dines JS, Dines DM, Altchek DW. Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique. J Shoulder Elbow Surg. 2010 Mar. 19(2 suppl):110-7. [Medline].
Curl LA. Return to sport following elbow surgery. Clin Sports Med. 2004 Jul. 23(3):353-66, viii. [Medline].
Darlis NA, Kaufmann RW, Sotereanos DG. Open surgical treatment of post-traumatic elbow contractures in adolescent patients. J Shoulder Elbow Surg. 2006 Nov-Dec. 15(6):709-15. [Medline].
Dines JS, Elattrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007 Aug 16. epub ahead of print. [Medline].
Gibson BW, Webner D, Huffman GR, Sennett BJ. Ulnar collateral ligament reconstruction in major league baseball pitchers. Am J Sports Med. 2007 Apr. 35(4):575-81. [Medline].
Goren D, Budoff JE, Hipp JA. Isometric placement of lateral ulnar collateral ligament reconstructions: a biomechanical study. Am J Sports Med. 2010 Jan. 38(1):153-9. [Medline].
Grana WA, Boscardin JB, Schneider HJ, et al. Evaluation of elbow and shoulder problems in professional baseball pitchers. Am J Orthop. 2007 Jun. 36(6):308-13. [Medline].
Halpern BC. Elbow and arm injuries. Birrer RB, ed. Sports Medicine for the Primary Care Physician. 2nd ed. Boca Raton, Fla: CRC Press; 1994. 435-41.
Hyman J, Breazeale NM, Altchek DW. Valgus instability of the elbow in athletes. Clin Sports Med. 2001 Jan. 20(1):25-45, viii. [Medline].
Jobe FW, Conway JE, Bradley JP. Ulnar neuritis and medial elbow instability. Curr Ther Sports Med. 1995. 118-23.
Lee GH, Limpisvasti O, Park MC, McGarry MH, Yocum LA, Lee TQ. Revision ulnar collateral ligament reconstruction using a suspension button fixation technique. Am J Sports Med. 2010 Mar. 38(3):575-80. [Medline].
Morrey BF, Regan WD. Throwing injuries. DeLee JC, Drez D Jr, Miller MD, eds. Delee & Drez's Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders Co; 1994. 882-3.
Purcell DB, Matava MJ, Wright RW. Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res. 2007 Feb. 455:72-7. [Medline].
Sasaki J, Takahara M, Ogino T, et al. Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players. J Bone Joint Surg Am. 2002 Apr. 84-A(4):525-31. [Medline].
Seiber KS, Savoie FH, McGarry MH, Gupta R, Lee TQ. Biomechanical evaluation of a new reconstruction technique of the ulnar collateral ligament in the elbow with modified bone tunnel placement and interference screw fixation. Clin Biomech (Bristol, Avon). 2010 Jan. 25(1):37-42. [Medline].