Elbow Ulnar Collateral Ligament Injury

Aka: Elbow Ulnar Collateral Ligament Injury, Ulnar Collateral Ligament Injury, Elbow UCL Injury, UCL Injury, Elbow Ulnar Collateral Ligament Sprain, Elbow MCL Injury, Elbow Medial Collateral Ligament Injury

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II. Pathophysiology

  1. Injury typically occurs with overhead throwing (e.g. baseball, volleyball)

III. Symptoms

  1. Pop heard and felt at the medial elbow with provocative activity (e.g. overhead throwing)
  2. Immediate pain and Ecchymosis over the medial elbow

IV. Signs

  1. See Elbow Moving Valgus Stress Test
  2. See Elbow Milking Maneuver
  3. Medial joint line tenderness
    1. Palpate over the ulnar collateral ligament
    2. Efficacy
      1. Test Sensitivity: >81%
      2. Test Specificity: 22%
  4. Medial joint line instability
    1. Laxity on elbow valgus stress
    2. Joint space opens more than 3 mm without firm endpoint
    3. Compare to opposite elbow

V. Management

  1. Initial approach
    1. RICE-M
    2. NSAIDs
    3. Consider sling
  2. Rehabilitation Exercise indications
    1. Grade 1-2 partial UCL tears
  3. Surgery indications
    1. High level athletes
    2. Complete UCL tears

VI. Complications

  1. Valgus elbow instability

VII. References

  1. Hariri (2010) Clin Sports Med 29(4): 619-44 [PubMed]
  2. Kane (2014) Am Fam Physician 89(8): 649-57 [PubMed]

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