Ulnar/Medial Collateral Ligament Strain

• Ulnar/Medial Collateral Ligament Strain:

  • medial elbow stability between 20 degrees to 120 degrees of elbow flexion is provided primarily by the ulnar collateral ligament
  • when the elbow is subjected to a chronic, excessive valgus force due to throwing related activities, microscopic tearing to the soft tissues at the medial side of the elbow can occur
  • this occurs in the late wind up/early acceleration phase of throwing
• Ulnar/Medial Collateral Ligament Strain:

  • what
  • microscopic tears to the ulnar collateral ligament
  • where
  • pain over the medial elbow +/- reduced throwing capacity
  • how
  • chronic, excessive valgus force due to throwing related activities
  • can also be acute traumatic excessive valgus force
  • who
  • more common in throwing athletes - repetitive microtrauma (repetitive tears to the ulnar collateral ligament)
• Ulnar/Medial Collateral Ligament Strain - Subjective Features:

  • gradual onset of pain occurs when 50% or more of maximal effort is reached
  • acute injury - approx 50% hear/feel a pop/sharp pain - unable to continue throwing
  • +/- numbness/tingling in distribution of ulnar nerve
  • chronic injuries may not be obvious - may present as pain/reduced throwing velocity
• Ulnar/Medial Collateral Ligament Strain - Objective Features:

  • observations
  • potential flexion contracture of the forearm muscles
  • palpation
  • tenderness over ulnar collateral ligament/towards insertion site
  • ROM
  • reduced extension - secondary to synovitis/loose bodies/flexion contracture
  • special tests
  • valgus instability (positive valgus stress test)
• Ulnar/Medial Collateral Ligament Strain - Special Tests & Investigations:

  • Valgus Stress Test
  • Investigations:
  • Valgus Stress Xrays:
  • opening of more than 3 mm at the joint line is considered diagnostic of valgus instability
  • MRI:
  • ligament thickening/tears
  • gold standard
• Ulnar/Medial Collateral Ligament Strain - Management:

  • advice and education
  • explain diagnosis
  • complete rest from throwing for 6+ weeks
  • address fears/unhelpful beliefs
  • symptom control
  • complete rest from throwing/aggravating activities for 6+ weeks
• Ulnar/Medial Collateral Ligament Strain - Management:

  • build capacity
  • restore full ROM
  • improve joint ROM
  • increase muscle length
  • exercises to improve
  • muscle strength and endurance - especially flexor digitorum superficialis and flexor carpi ulnaris
  • motor control
  • proprioception
  • return to function
  • optimise throwing mechanics
  • throwing/sport specific rehab
  • review throwing technique
  • only return to throwing when asymptomatic and examination is normal
• Ulnar/Medial Collateral Ligament Strain - Surgical Management:

  • indicated for full ulnar collateral ligament rupture and/or chronic instability
  • usually a surgical reconstruction
  • post op rehab
  • at least 12 months until pts can return to throwing
  • goal to restore full ROM, full strength and be pain free before returning to throwing