Ulnar Collateral Ligament Injury Clinical Presentation

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

History

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  • Medial elbow pain is the most common symptom in athletes who throw. Pain may be especially prominent during the acceleration phase of the overhead throw.

  • Pain is often chronic or recurrent, and it may lead to a slow erosion of the patient's throwing ability.

  • Athletes may report having had similar pain in previous seasons of throwing.

  • Rest generally helps to relieve the pain.

  • Occasionally, during a single throw, athletes may experience acute pain over the medial elbow, sometimes associated with a popping sensation, that causes them to immediately stop throwing.

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Physical

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  • Medial elbow tenderness and swelling are the most notable findings. Tenderness is commonly found approximately 2 cm distal to the medial epicondyle. UCL tenderness may occasionally be difficult to differentiate from flexor pronator tendinitis, but the pain of flexor pronator tendinitis is aggravated by resisting forearm pronation.

  • Loss of elbow range of motion (ROM) is occasionally observed.

  • With acute rupture, ecchymosis may be observed over the medial elbow.

  • Pain may be reproduced when the patient makes a clenched fist.

  • Valgus stress with the elbow in 25° of flexion (elbow abduction stress test) reproduces pain and may cause joint opening. The affected side should be compared with the contralateral elbow as a reference for baseline laxity.

  • Some throwing athletes have a baseline asymmetry; therefore, preseason documentation of baseline elbow laxity in elite athletes, especially pitchers, may be helpful for comparison if an injury occurs during the season.

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Causes

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  • Repetitive throwing motions are the most common cause of UCL injury in the athlete.

  • Traumatic valgus stress to the elbow during a fall or with the arm outstretched may lead to UCL rupture in association with elbow dislocation.

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