Medial (ulnar) collateral ligament injury

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