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UL > MCL Sprain or Tear > Flashcards

MCL Sprain or Tear Flashcards

1
Q

Pathophysiology

A
  • MCL originated at medial epicondyle of humerus and insert onto the tubercle on the proximal ulna, olecranon and joint capsule
  • posterior band tightens in flex
  • May be associated with RH joint damage and osteochondral deficits
  • GRADES
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2
Q

Prevalence

A

Throwers/ pitchers

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3
Q

MOI

A
  • Traumatic (valgus force) between 120-70 degrees of elbow flexion
  • Overuse= Repetitive valgus force with throwing (late cocking or early acceleration phase)–> cause micro tearing/inflammation/scarring of the ligament leading to laxity, instability and eventual rupture
  • may have felt a pop
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4
Q

Complaints

A
  • problems with throwing = pain, decreased power, accuracy
  • paraesthesia (secondary symptom)
  • clicking, locking, or stiffness
  • may report a popping sound
  • possible night pain if complete rupture
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5
Q

Physical examination

Functional

A
  • throwing aggravated and reproduces the pain
  • decrease power and accuracy
  • pain with movement of the affected joint itself
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6
Q

Physical exam:

Observation

A
  • swelling at medial elbow (2cm distal to medial epicondyle)
  • loss of continuity of medial epicondyle
  • holding the arm in slight flexion (flex contracture of the forearm muscles)
  • Synovitis/loose body formation around olecranon
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7
Q

Physical exam:

Palpation

A
  • pain on palpation of MCL
  • swelling
  • hypersensitivity of ulnar nerve
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8
Q

Physical exam:

Movement and muscle exam

A
  • start with AROM
  • Positive valgus stress test (opening medial aspects of joints)= 30 deg elbow flex and full ext, compare side.
  • Decreased ext ROM= decreased muscle length of elbow flexors
  • Decreased power-specific throwing
  • throwing may have stiffness in elbow extension
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9
Q

Physical exam:

Special test

A

Valgus stress test (increased movement and altered end feel).

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10
Q

Imaging

A

US, radiography–> especially for grade 2 or 3 tear, for prognosis

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11
Q

Differential diagnosis

A
  • Medial epicondylagia
  • flexor tendon tear
Aware of associated problems 
-osteochondral deficits
loose bodies around olecranon 
-Humeralradial joint problems 
-Ulnar nerve hypersensitivity
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12
Q

Treatment Aims

A
  • decreased pain during throwing
  • improve power and accuracy in throwing/javelin/baseball
  • improve strength of wrist flexors and pronators
  • improve medial stability at the elbow
  • Maintain CV fitness
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13
Q

Outcome measures

A
  • Pain when throwing
  • throwing accuracy
  • throwing power
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14
Q

Prognosis

A

Non- surgical

  • 25 wks 42% throwing
  • 27 days 90% footballers

Surgical
83% thrower at 10-26 mths

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15
Q

Treatment A&E

A
  • include prognosis
  • RICE
  • NSAID’s
  • activity modification–> no valgus stress
  • gentle ROM to prevent stiffness
  • technique correction
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16
Q

Management approach

A

Phase 1

  • Rest throwing 2-3 months
  • NSAIDS
  • Ice elbow 10 mins, times daily
  • Tape–> very important first 10 day to protect structures
  • Gentle active and passive ROM for elbow flex and pronators
  • after 2 wks progress to loading on wrist flexors =guide by symptoms, can start isometric and motor control earlier

Phase 2 (if pain free)

  • discontinue splint or brace
  • progress to UL strengthening program to all muscle groups= improve power for throwing (tricep dips, rotator cuff)
  • begin throwing progression at 3 mths
  • elbow hypertension brace may be used for throwing/lifting
17
Q

Treatment manual therapy

A

Will hold elbow in flex therefore address any ext deficits

  • soft tissue massage
  • AP glides
  • Gentle ROM
  • No valgus stress

Strengthening wrist flexors and forearm pronators–> stabilise medial elbow

  • pain-free strengthening
  • 5-8 pain free ROM

Functional specific strengthening of shoulder and elbow muscles

  • specific muscles required for specific functional tasks
  • progress from general postures to functional postures
  • eccentic control.. 5-8 RM
18
Q

Throwing specific exercises

A

Power training for wrist flexor and forearm pronators
-1-3 RM with high velocity

Power training for the shoulder and elbow muscles

19
Q

Correction of biomechanics

A
  • correction of throwing biomechanics
  • rotation of the body out of the late cocking phase too early
  • retraining the athlete to contract the wrist flexors and pronators through the acceleration phases so as to provide greater stability to MCL
20
Q

Pain free throwing program

A

Phase 1

  • Approp mech from flat ground no mound
  • progress velocity by increasing throwing distance

Phase 2

  • off the mound for pitchers
  • increasing perceived effort 50–>75–>100%
  • increase volume from 2 sets to 2 sets of 25 throw pain free

UL (5 decks)

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