ulnar collateral ligament of the elbow
DESCRIPTION
Ulnar Collateral Ligament of the Elbow. Jacob Kotlicky Program Coordinator Return to Sport – Memorial Hospital West. Articulations and Motions. Humeroulnar- Flexion & Extension Humeroradial – Flexion/Extension, Pronation/Supination Proximal Radioulnar – Pronation/Supination - PowerPoint PPT PresentationTRANSCRIPT
ULNAR COLLATERAL LIGAMENT OF THE ELBOW
Jacob Kotlicky
Program Coordinator
Return to Sport – Memorial Hospital West
Articulations and Motions
Humeroulnar- Flexion & Extension Humeroradial – Flexion/Extension,
Pronation/Supination Proximal Radioulnar –
Pronation/Supination
Total ROM’s: Flex/Ext = 145˚-155˚Pro/Sup = 170˚-180˚
Ligamentous Support
Ulnar Collateral Ligament - Primary medial stabilizer
Lateral Ulnar Collateral Ligament – Primary lateral stabilizer
Radial Collateral Ligament – supports against varus force, maintains humeroradial articulation
Annular Ligament – permits external/internal rotation of radius & ulna
UCL Breakdown
3 directional bundles Anterior: Taut throughout full ROM,
primary against valgus force Posterior: Taught in flexion past 60˚ Transverse: Minimal support to medial
elbow
Injury History/Observations
20 y/o baseball pitcher junior classman w/ 0 spring innings played
to date on collegiate level Right hand dominant No previous history of elbow injury While throwing a curveball felt a “pop” and
instant pain. Threw two more pitches and felt his arm
was “detached” as pain increased Swelling over the medial aspect of R elbow
Palpations/Special Tests
No paresthesia, tinel’s sign, - fractures Tenderness at UCL and medial epicondyle. Pain with valgus stress w/ minimal gapping AROM, PROM, RROM all WNL Dermatomes/myotomes intact Suspected UCL sprain. Athlete prescribed naprosyn and went for
immediate MRI
MRI Findings
UCL derangement of advanced stage and degree
“High-grade insertional partial tear involving the UCL insertion into the sublime tubercle”
“Thinning and attenuation of the distal inserting fibers”
Prominent edema in flexor pronator musculature
Chondromalacia and synovial thickening about the region.
UCL Reconstruction “Tommy John Surgery”
High rate of return to play Tendon harvested. Typically palmaris
longus. Hamstring tendon for this athlete
Tendon prepared – looped through holes drilled in radius and ulna at ligamentous attachment sites
Looped into a figure 8 and then sutured together.
Rehabilitation Process
Athlete immediately placed in a functional hinge brace
Extension initially limited to 60˚ Total amount of time braced will be 5-6
weeks In-clinic 2 x week supplemented by HEP
on daily basis 4 way SLR, heel drags and HS stretches Shoulder isometrics
Rehabilitation Cont.
Began passive stretching of biceps on 11/17/08 – Athlete is hesitant with tightness and pain due to held flexion for nearly two weeks.
Return to Play Criteria
FULL ROM Strength must be equal to that of other
arm No c/o pain in elbow w/ activity Completion of shoulder program Medical clearance from Dr. K.
References
Koh, JL, Schafer, MF, Keuter, G, & Hsu, JE. Ulnar collateral ligament reconstruction in
elite throwing athletes. Arthroscopy. 22 (11): 1187-1191
Safran, MR. Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med. 23 (4): 643-663
Chen FS, Rokito AS, & Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. 9 (2): 99-113
Cain EL, & Dugas JR. History and examination of the thrower’s elbow. Clin Sports Med. 23 (3) 553-566
Limpisvasti O, ElAttrache NS, Jobe FW. Understanding shoulder and elbow injuries in baseball. J Am Acad Orthop Surg. 15 (3): 139-147
Hyman, J, Breazeale, NM, & Altchek, DW. Arthroscopic surgery for athletic elbow and wrist surgeries. Clin Sports Med. 20 (1): 5-21
Altcheck D, Hyman JL, Williams RJ. Ulnar collateral ligament reconstruction in throwers using the “docking” technique: two-year results. Sun Valley, ID, American Orthopaedic Association, 1999
Starkey C, Ryan J. Evaluation of Orthopedic and Athletic Injuries. 2nd ed. Philadelphia, Pa: FA Davis Company; 2002