Elbow Ucl Tear

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Elbow Ucl Tear

Authors, Editors, Case Information Author: Will Hollabaugh, MD Affiliation: Vanderbilt University Medical Center, Division of Sports Medicine Co Author(s): Stephen Schaaf, MD Senior Editor: Wesley Troyer, DO Clinical Vignette: A 16-year-old right-hand-dominant male baseball pitcher presented with acute onset right medial elbow pain while pitching during a baseball game. Exam of his right elbow displayed tenderness to palpation of the medial elbow immediately distal to the medial epicondyle, and pain and laxity with valgus stress test and milking maneuver. Type of Probe Used: 13-5 MHz Linear Array Transducer Unlabeled Long Axis View of the Injured Reft UCL Unlabeled Long Axis View of the Injured Reft UCL Labeled Long Axis View of the Injured Reft UCL Labeled Long Axis View of the Injured Reft UCL. The mid-portion of the right ulnar collateral ligament appears anechoic with complete fiber discontinuity. Unlabeled Long Axis View of the Uninjured Left UCL Unlabeled Long Axis View of the Uninjured Left UCL Labeled Long Axis View of the Uninjured Left UCL Labeled Long Axis View of the Uninjured Left UCL with normal findings. #5 - Video View Video Long Axis Dynamic Valgus Stress Testing of the Injured Right UCL displaying dynamic humeroulnar joint gapping. #6 - Video View Video Long Axis Dynamic Valgus Stress Testing of the Uninjured Left UCL displaying no dynamic humeroulnar joint gapping. Interpretation Image Interpretation: The mid-portion of the right ulnar collateral ligament appeared anechoic with complete fiber discontinuity, consistent with a full thickness ulnar collateral ligament tear. At rest, the right humeroulnar joint was 4.5 mm wide and left humeroulnar joint was 4.0 mm wide. With dynamic valgus stress test, the right humeroulnar joint gapped greater than 1.0 mm wide in comparison to no gapping of the left humeroulnar joint. Teaching Pearl: Both static and dynamic ultrasound evaluation is important when assessing an elbow UCL tear. Static imaging should evaluate ligament fiber continuity and echotexture, while dynamic valgus stress ultrasound can show abnormal medial ulnohumeral joint gapping compared with the uninjured contralateral side. One should perform the exam with consistent elbow positioning, commonly around 70 degrees of flexion, and document rest and stress measurements. Dynamic gapping should be documented with any associated symptoms. MRI should be obtained when surgical planning is being considered. References: 1. Sutterer BJ, Boettcher BJ, Payne JM, Camp CL, Sellon JL. The role of ultrasound in the evaluation of elbow medial ulnar collateral ligament injuries in throwing athletes. Curr Rev Musculoskelet Med. 2022;15(6):535-546. doi:10.1007/s12178-022-09793-0 2. Park JY, Kim H, Lee JH, et al. Valgus stress ultrasound for medial ulnar collateral ligament injuries in athletes: is ultrasound alone enough for diagnosis? J Shoulder Elbow Surg. 2020;29(3):578-586. doi:10.1016/j.jse.2019.12.005 3. De Smet AA, Winter TC, Best TM, Bernhardt DT. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers. Skeletal Radiol. 2002;31(11):671-676. doi:10.1007/s00256-002-0558-0
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Unlabeled Long Axis View of the Injured Reft UCL

Labeled Long Axis View of the Injured Reft UCL

Unlabeled Long Axis View of the Uninjured Left UCL

Labeled Long Axis View of the Uninjured Left UCL

#5 - Video

#6 - Video

Interpretation

UPCOMING EVENTS

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