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 Left UCL unlabeled Long-axis view of the left (unaffected) medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar joint. Left UCL labeled Long-axis view of the left (unaffected) medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar joint, with normal findings. Right UCL unlabeled Long-axis view of the right (affected) medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar joint. Right UCL labeled Long-axis view of the right medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar joint. The mid-portion of the right ulnar collateral ligament appears anechoic with complete fiber discontinuity. #5 - Video View Video Affected side dynamic UCL stress: Long-axis video of the right medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar join undergoing valgus stress test displaying dynamic humeroulnar joint gapping. #6 - Video View Video Unaffected side dynamic UCL stress: Long-axis video of the left medial epicondyle, common flexor tendon, ulnar collateral ligament and humeroulnar join undergoing valgus stress test 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: A combination of both static and dynamic ultrasound evaluation is important when assessing for an ulnar collateral ligament tear. Static ultrasound evaluation should optimally be performed at 70 degrees of elbow flexion. A complete ulnar collateral ligament tear is suggested when anechoic fiber discontinuity is present. On dynamic ultrasound evaluation during valgus stress test, a complete ulnar collateral ligament tear is suggested when evaluation displays gapping at the humeroulnar joint, especially if there is greater than or equal to 1.0 mm asymmetric gapping compared to the contralateral joint.
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

Left UCL unlabeled

Left UCL labeled

Right UCL unlabeled

Right UCL labeled

#5 - Video

#6 - Video

Interpretation

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