Elbow Collateral Ligament Insufficiency Workup

Updated: Aug 02, 2021
  • Author: Rahi K Yallapragada, MBBS, MRCS, FRCS(T&O), MCh(Orth); Chief Editor: S Ashfaq Hasan, MD  more...
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Workup

Laboratory Studies

The white blood cell count (WBC), the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) activity should be assessed to rule out any active inflammation.

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Imaging Studies

Radiography

Standard radiographs of the elbow include the anteroposterior (AP) view and the true lateral view. Special views include the following:

  • Axial projections to evaluate the olecranon fossa
  • Oblique views to assess the radial head
  • Stress views to evaluate joint stability (>5 mm abnormally wide joint space on the medial side, with the elbow flexed to 30° in a medial collateral ligament [MCL] tear)

Ultrasonography

Ultrasound examination commonly shows the following:

  • Widening of the medial joint space
  • Lateral shift of the proximal part of the ulna
  • Deformity of the contour of the ulnar collateral ligament (UCL)
  • Osteophyte formation on the distal-medial corner of the trochlea

Magnetic resonance imaging, with or without arthrography

Magnetic resonance imaging (MRI) can be helpful in identifying soft-tissue masses, articular cartilage anatomy, ligament ruptures, and chondral defects. [28]

With MCL tears, T2-weighted MRI will show focal discontinuity of the ligament and joint fluid extravasation.

High-resolution MRI of the elbow, using a microscopy surface coil with a 1.5-Tesla (1.5T) clinical machine, is a promising method for accurately characterizing the normal anatomy of the elbow and depicting its lesions in detail (eg, partial MCL injury or a small avulsion of the medial epicondyle).

MCL abnormalities such as thickening, signal heterogeneity, or discontinuity consistent with posteromedial impingement can be seen in asymptomatic throwers' elbows. These baseline findings must be considered when MRI is being used in making treatment decisions. MCL thickening and posteromedial subchondral sclerosis are more consistent findings of posteromedial impingement seen in throwers' elbows.

Other imaging studies

Computed tomography (CT) is useful for delineating complex osseous anatomy. CT arthrography may be useful for defining capsular defects (extracapsular contrast extravasation) and loose bodies. Bone scanning is sensitive but not specific for differentiating between stress fractures, healing fractures, infections, and tumors.

Although other studies can be helpful in confirming a diagnosis (eg, a positive manual pivot shift test result), they are somewhat insensitive. Thus, clinical judgment should prevail in making treatment decisions.

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Other Tests

Electromyography (EMG) and nerve conduction studies are used to evaluate suspected nerve compression syndromes.

 

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