Sections

Sections Elbow Collateral Ligament Insufficiency
Overview
Presentation
Workup
Treatment
Media Gallery
References

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.

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.

Other Tests

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

Treatment & Management

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Media Gallery

Horii circle.
Schematic diagram of medial collateral ligament of elbow shows 3 bundles. Anterior bundle is major stabilizer of elbow to valgus stress.
Moving valgus stress test. Pronation, valgus of forearm, and internal rotation of shoulder lead to pain at 70-120° flexion arc.
Docking (top) and figure-eight (bottom) techniques for medial collateral ligament (MCL) reconstruction. Single-strand reconstruction with ulnar Endobutton fixation technique and 2-strand docking technique appear to be viable options for reconstruction of MCL of elbow to resist valgus loading.
Single-strand reconstructions with interference screw (top) and Endobutton (bottom).
LUCL (lateral ulnar collateral ligament) isometric point.
LUCL (lateral ulnar collateral ligament) isometric point.

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Author

Rahi K Yallapragada, MBBS, MRCS, FRCS(T&O), MCh(Orth) Specialty Doctor, Trauma and Orthopaedics, Lister Hospital, UK

Rahi K Yallapragada, MBBS, MRCS, FRCS(T&O), MCh(Orth) is a member of the following medical societies: Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Janos T Patko, MD, MRCS Consultant Orthopaedic & Trauma Surgeon, Special Interest in Lower Limb Arthroplasty & Revision,Honorary Senior Clinical Lecturer Sheffield UniversityDepartment of Orthopedics and Trauma, Barnsley NHS Foundation Trust, UK

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.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India

Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedics Overseas, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Sections Elbow Collateral Ligament Insufficiency
Overview
Presentation
Workup
Treatment
Media Gallery
References

Elbow Collateral Ligament Insufficiency Workup

Laboratory Studies

Imaging Studies

Radiography

Ultrasonography

Magnetic resonance imaging, with or without arthrography

Other imaging studies

Other Tests

Elbow Collateral Ligament Insufficiency Workup

Laboratory Studies

Imaging Studies

Radiography

Ultrasonography

Magnetic resonance imaging, with or without arthrography

Other imaging studies

Other Tests

References

Tables

Contributor Information and Disclosures

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