LIGAMENTOUS INJURY

Question 1

Ulnar Collateral Ligament Tear

Def/Causes

Answer 1

(1) Ulnar collateral ligament is primary structure that resists valgus stress at the elbow
(2) Trauma to this ligament is rare
(3) Common injury to ulnar collateral ligament comes from excessive overhead throwing
motions (baseball pitcher)
(4) Repetitive valgus stress to the elbow may result in instability or disability of the ulnar
collateral ligament

Question 2

Symptoms

Answer 2

(1) With acute onset patient will describe a “pop” while throwing
(2) Most commonly patients experience a gradual onset of symptoms with progressive
medial elbow pain with valgus stresses
(3) May experience symptoms consistent with ulnar neuritis

Question 3

Physical Exam

(1) Visual
(2) Palpation
(3) ROM
(4) Muscle Test
(5) Special Tests

Answer 3

(1) Visual
(a) Generally edema and ecchymosis are absent
(2) Palpation
(a) Tenderness over ulnar collateral ligament
(3) ROM
(a) Possible loss of terminal elbow extension
(4) Muscle Test
(a) Usually unremarkable or limited by pain
(5) Special Tests
(a) Positive Moving valgus stress test-valgus stress is applied to elbow while moving
elbow into full flexion and extension. Test is positive when more pain is felt
between 70 degree and 120 degrees of flexion.

Question 4

Diagnostic Tests

Answer 4

(1) AP and Lateral radiographs are needed to rule out fracture
(a) Posteromedial olecranon osteophytes, loose bodies and spurring may be seen in
chronic cases
(2) MRI with contrast is a reasonable diagnostic tool for ulnar collateral ligament pathology

Question 5

Treatment

Answer 5

(1) Light Duty- Activity Modification
(2) Ice for acute injury
(3) NSAIDS
(4) Pain free elbow and wrist stretching and strengthening exercises

Question 6

Referral Decisions/Red Flags

Answer 6

(1) Failed nonsurgical management in patients that consistently perform activities that
result valgus stress should be consulted to orthopedics.