You are here

Medial Elbow Instability S53.449A 841.1

 elbow ligaments

throwing athlete picture

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: medial collateral ligament sprain, medial elbow instability, elbow UCL rupture, UCL instability, ulnar collateral ligament tear

 

Medial Elbow Instability ICD-10

 

A- initial encounter

D- subsequent encounter

S- sequela

Medial Elbow Instability ICD-9

  • 841.1 (sprain and strain of elbow; ulnar collateral ligament)

Medial Elbow Instability Etiology / Epidemiology / Natural History

  • Throwing exposes the medial elbow to high tension forces and the lateral elbow to high compression forces.
  • Repetitive valgus stresses to the elbow occuring during the late cocking and acceleration phases of throwing can lead to MCL incompetence, ulnar neuritis and posteromedial olecranon impingement.
  • Associated with Baseball, javelin, and raquet sports (tennis, )

Medial Elbow Instability Anatomy

  • Valgus stability to the elbow is provided by: MCL, olecranon/trochlear articulation, flexor-pronator muscle mass (FCU is primary, FDS is secondary), radiocapitellar articulation,
  • Elbow MCL consists of anterior bundle, posterior bundle and transverse segment
  • Anterior bundle: origin=inferior aspect of the medial epicondyle. Insertion=sublime tubercle of ulna. Primary restraint to valgus stress at the elbow.
  • Posterior bundle; Origin=medial epicondyle slightly posterior to its most inferior portion. Insertion=broadly onto the olecranon
  • See also Elbow Anatomy.

Medial Elbow Instability Clinical Evaluation

  • Pain localized to the medial elbow generally in the late-cocking or acceleration phases of throwing. May or may not have preceeding injury.
  • Acute injury may be associated with a "pop" sensation.
  • Medial elbow tenderness, loss of throwing velocity.
  • Associated ulnar neuritis causing paresthesias in the posteromedial elbow to the ring and small fingers may be the first complaint.
  • Elbow effusion: uncommon. Pts with large effusion will hold the elbow flexed 70° to 80°, which corresponds with the greatest capsular volume. (Timmerman LA,AJSM 1994;22: 26–32, 1994).
  • Valgus Stress Test: valgus load applied to elbow with the elbow flexed 20° . Positive results = reproduction of medial elbow pain and valgus laxity greater on injured side as compared to contralateral side.
  • Moving Valgus Stress Test: rapid extention from full flexion while maintaining a constant valgus stress. Positive result = reproduction of medial elbow pain.
  • Milking maneuver: patient or examiner pulls on the patient's thumb creating a valgus stress, witht he patient's forearm suppinated and elbow flexed 90°. Medial elbow pain indicates medial elbow instability.

Medial Elbow Instability Xray / Diagnositc Tests

  • A/P, Lateral and oblique elbow xrays. Generally normal. May show MCL calcification, medial humeral osteophytes, ulnar osteophytes, posterior olecranon spurring or loose bodies may be seen in chronic cases.
  • Valgus stress xrays: >3mm medial opening on side-to-side comparisions is diagnositic of valgus instability
  • MRI arthrogram: study of choice for elbow MCL injury. Evaluate for T sign of ulnar avulsion, humeral MCL avulsion or midsubstance tearing. Normal MCL appears as a thin band of low intensity along the medial elbow. Tearing is indicated by signal attenuation or absence. (Timmerman LA, AJSM 1994;22:26), (Munshi M, Radiology 2004;231:797), (Schwartz ML, Radiology 1995;197: 297).
    82. Sisto DJ, Jobe FW, Moynes DR, et al: An el
  • CT arthrography: sensitivity of 86%, specificity of 91%. (Timmerman LA, AJSM 1994;22:26),

Medial Elbow Instability Classification / Treatment

  • Non-operative: Rest from throwing. Physical therapy with stretching, flexor-pronator strengthening and modalities. May start sport-specific activites at 3 months focused on adjusting patients throwing mechanics. 42% return to previous level of competition at an average 24.5 weeks after diagnosis (Rettig AC, AJSM 2001;29:15).
  • Throwing athlete, failed non-op treatment: MCL Reconstruction.
  • Non-throwing athlete, failed non-op treatment; women: MCL Reconstruction or capsular plication / MCL repair (Argo D, AJSM 2006;34:431).

Medial Elbow Instability Associated Injuries / Differential Diagnosis

Medial Elbow Instability Complications

  • Posteromedial olecranon impingement
  • Ulnohumeral arthritis

Medial Elbow Instability Follow-up Care

  • 9weeks: start isotonic strengthening with concentric flexor-pronator and eccentric elbow flexor training.
  • Full speed pitching not recommended for 12 months after reconstruction.

Medial Elbow Instability Review References

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer