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Medial (ulnar) collateral ligament injury

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Elbow ulnar collateral ligament insufficiency is commonly seen in sports participants involved in overarm-throwing sports such as cricket, baseball and tennis

  • patients present with medial elbow pain
    • condition is usually chronic and there may be a history of long-term deterioration in the ability to throw
    • trauma and elbow dislocation injuries may result in acute damage to the ulnar ligament
  • examination reveals medial elbow tenderness, approximately 2 cm distal to the medial epicondyle, with or without swelling
    • pain may be reproduced by asking the patient to make a clenched fist or by placing the elbow in a valgus stress in 25º of flexion (elbow abduction stress test)
    • affected side should be compared with the contralateral elbow for laxity

Investigation

  • diagnosis can be made clinically
  • x-ray is useful in excluding other causes of elbow pain (osteoarthritis, avulsion fractures, loose bodies)
  • MRI is the investigation of choice

Management

  • acute injuries should be referred for surgical intervention
  • chronic injuries should be referred for physiotherapy
  • patient should stop all throwing or exacerbating factors until pain-free
  • surgical referral should be considered in chronic injuries after failed physiotherapy with appropriate rest or if the elbow is unstable

Notes:

  • ulnar ligament is composed of three bands: anterior, posterior and transverse. The anterior band arises from the medial epicondyle and inserts on the proximal ulna.

Reference:

  1. Arthritis Research UK (2011). Hands On (11) - upper limb in primary care

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