Medial Elbow Instability Resulting from Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2018 ◽  
Vol 34 (12) ◽  
pp. e23
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammound ◽  
Steven B. Cohen ◽  
Levon Nazarian ◽  
Michael M. Ciccotti
Keyword(s):  
Ulnar Collateral Ligament ◽  
Elbow Instability ◽  
Collateral Ligament ◽  
Partial Tears ◽  
Cadaveric Model

Medial elbow stability assessment after ultrasound-guided ulnar collateral ligament transection in a cadaveric model: ultrasound versus stress radiography

2019 ◽  
Vol 28 (6) ◽  
pp. 1154-1158 ◽  
Author(s):  
Tariq K. Hendawi ◽  
Nicole K. Rendos ◽  
Christopher S. Warrell ◽  
Joshua G. Hackel ◽  
Steve E. Jordan ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Stability Assessment ◽  
Stress Radiography ◽  
Ultrasound Guided ◽  
Collateral Ligament ◽  
Cadaveric Model

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2020 ◽  
Vol 48 (11) ◽  
pp. 2613-2620
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammoud ◽  
Christopher C. Dodson ◽  
Steven B. Cohen ◽  
Levon N. Nazarian ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Diagnostic Modality ◽  
Partial Tear ◽  
Partial Tears ◽  
Early Reconstruction ◽  
Anterior Posterior

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic “T-sign.” Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

scholarly journals Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773129 ◽  
Author(s):  
Jason L. Zaremski ◽  
JoAnna McClelland ◽  
Heather K. Vincent ◽  
MaryBeth Horodyski
Keyword(s):  
Odds Ratio ◽  
Injury Severity ◽  
Ulnar Collateral Ligament ◽  
International Classification Of Diseases ◽  
Collateral Ligament ◽  
Surgical Interventions ◽  
Injury Management ◽  
Nonsurgical Management ◽  
Older Athletes ◽  
Partial Tears

Background: Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known. Purpose/Hypothesis: The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes. Study Design: Descriptive epidemiological study. Methods: Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification. Results: There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) ( P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32). Conclusion: Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.

scholarly journals MAGNETIC RESONANCE IMAGING FINDINGS ASSOCIATED WITH ULNAR COLLATERAL LIGAMENT TEARS IN ADOLESCENT BASEBALL PITCHERS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Ben Cox ◽  
Hillary Plummer ◽  
Eric Goodrich ◽  
James Andrews ◽  
Michael Saper
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ulnar Collateral Ligament ◽  
High Grade ◽  
Type Ii ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Plain Radiographs ◽  
Partial Tears ◽  
Baseball Pitchers

BACKGROUND: The number of ulnar collateral ligament (UCL) injuries in adolescent baseball pitchers has risen over the past 2 decades with the incidence of UCL reconstructions also increasing dramatically over that time period. The Joyner-Andrews magnetic resonance imaging (MRI) classification of UCL tears has previously been described to describe the grade and location of tears, which can aid in surgical decision-making. However, the classification of UCL tears in the at-risk adolescent population has yet to fully investigated. Improving our knowledge of these injuries is crucial to help drive targeted evidence-based treatment strategies. The purpose of this study was to examine the grade and location UCL tears using the Joyner-Andrews MRI classification in a large group of adolescent baseball pitchers. METHODS: We reviewed 225 symptomatic adolescent (aged =19 years) male baseball pitchers with UCL injuries treated by the senior author from 2007-2016. All patients had failed conservative treatment prior to evaluation. Pitchers with a prior history of elbow surgery were excluded. Plain radiographs and MRI arthrograms were evaluated for each patient to categorize the UCL injury and associated pathology. The images were reviewed by a sports medicine-trained orthopedic surgeon. UCL tear grade and location were classified using the Joyner-Andrews classification. RESULTS: The mean age at the time of evaluation was 17.2 ± 1.5 years. 56% of the patients were high school athletes. The majority (59.1%) of UCL tears were high-grade partial tears (Type II). Of those 53.4% were on the humeral side (Type II H). The least common tear types were low-grade partial tears (I) and tears in more than one location (Type IV) in 1.3% and 0.9% of patients, respectively. Plain radiographs revealed 31.4% of patients had abnormal findings; calcifications and olecranon osteophytes were present in 10% and 13% of patients, respectively and more commonly occurred in patients with Type II tears. CONCLUSIONS: The results of this study showed that the majority of adolescent baseball pitchers (59%) sustain high-grade partial tears of the UCL. These findings suggest that effective non-reconstruction options such as platelet-rich plasma and UCL repair with internal brace augmentation could be ideal alternatives to UCL reconstruction for these young patients. The high percentage of radiographic abnormalities in these patients highlights the adaptive changes about the elbow in response to the repetitive stresses experienced by the young elbow during throwing.

Elbow Instability

2021 ◽  
Vol 25 (04) ◽  
pp. 574-579
Author(s):  
Dimitri N. Graf ◽  
Fritz Benjamin ◽  
Samy Bouaicha ◽  
Reto Sutter
Keyword(s):  
Soft Tissue ◽  
Radial Head Fracture ◽  
Anterior Part ◽  
Chronic Phase ◽  
Ulnar Collateral Ligament ◽  
Phase Imaging ◽  
Elbow Instability ◽  
Collateral Ligament ◽  
Chronic Instability ◽  
Valgus Stress

AbstractThe stability of the elbow is based on a combination of primary (static) and secondary stabilizers (dynamic). In varus stress, the bony structures and the lateral ulnar collateral ligament (LUCL) are the primary stabilizers, and in valgus stress, the ulnar collateral ligament (UCL) is the primary stabilizer. The flexor and extensor tendons crossing the elbow joint act as secondary stabilizers. Elbow instability is commonly divided into acute traumatic and chronic instability. Instability of the elbow is a continuum, with complete dislocation as its most severe form.Posterolateral rotatory instability is the most common elbow instability and can be detected at imaging both in the acute as well as the chronic phase. Imaging of suspected elbow instability starts with radiographs. Depending on the type of injury suspected, it is followed by magnetic resonance imaging (MRI) or computed tomography evaluation for depiction of a range of soft tissue and osseous injures. The most common soft tissue injuries are tears of the LUCL and the radial collateral ligament; the most common osseous injuries are an osseous LUCL avulsion, a fracture of the coronoid process, and a radial head fracture.Valgus instability is the second most common instability and mostly detected in the chronic phase, with valgus extension overload the dominant pattern of injury. The anterior part of the UCL is insufficient in valgus extension overload due to repetitive medial tension seen in many overhead throwing sports, with UCL damage readily seen at MRI.

scholarly journals The Use of Platelet-Rich Plasma for Conservative Treatment of Partial Ulnar Collateral Ligament Tears in Overhead Athletes: A Critically Appraised Topic

2020 ◽  
Vol 29 (4) ◽  
pp. 509-514
Author(s):  
Bradley J. Conant ◽  
Nicole A. German ◽  
Shannon L. David
Keyword(s):  
Conservative Treatment ◽  
Treatment Program ◽  
Platelet Rich Plasma ◽  
Ulnar Collateral Ligament ◽  
The Body ◽  
Current Evidence ◽  
Evidence Based ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
Partial Tears

Clinical Scenario: Rates of ulnar collateral ligament (UCL) injuries continue to rise in overhead athletes of all ages. Surgical interventions require minimally 6 months and up to 2 years of rehabilitation. Younger athletes and those with partial tears have seen positive results with conservative treatment approaches. Platelet-rich plasma (PRP) continues to be studied with various orthopedic injuries, and its use has the potential to improve return-to-sport rates and reduce recovery time. Focused Clinical Question: Do PRP injections improve conservative treatment outcomes in overhead athletes with partial tears of the UCL compared with conservative treatment alone regarding return to participation? Summary of Search, Best Evidence Appraised, and Key Findings: A literature search was performed to locate all studies investigating outcomes when PRP is included in a conservative treatment program for overhead athletes with partial UCL tears. Three case series qualified and were reviewed. Clinical Bottom Line: Current evidence suggests that including PRP in a conservative treatment program can improve outcomes in overhead athletes with partial UCL tears. Athletes whose treatment included PRP show higher return-to-competition rates and shorter recovery times compared with athletes who used rehabilitation alone. Athletes with grade-1 and proximal-based grade-2 injuries returned to competition at rates comparable with athletes undergoing surgical intervention. For optimal conservative management outcomes, PRP injections should be recommended for treatment of partial UCL tears. Strength of Recommendation: The studies qualifying for inclusion are level 4 evidence based on the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence. The studies are well designed and show consistent results, but higher level studies need to demonstrate similar results to improve the body of evidence. The strength of recommendation is C.

scholarly journals Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199005
Author(s):  
Jonathan S. Yu ◽  
James B. Carr ◽  
Jacob Thomas ◽  
Julianna Kostas ◽  
Zhaorui Wang ◽  
...  
Keyword(s):  
Social Media ◽  
Public Perception ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Social Media Analytics ◽  
Care Providers ◽  
Collateral Ligament ◽  
The Past ◽  
Positive Sentiment ◽  
Negative Sentiment

Background: Social media posts regarding ulnar collateral ligament (UCL) injuries and reconstruction surgeries have increased in recent years. Purpose: To analyze posts shared on Instagram and Twitter referencing UCL injuries and reconstruction surgeries to evaluate public perception and any trends in perception over the past 3 years. Study Design: Cross-sectional study. Methods: A search of a 3-year period (August 2016 and August 2019) of public Instagram and Twitter posts was performed. We searched for >22 hashtags and search terms, including #TommyJohn, #TommyJohnSurgery, and #tornUCL. A categorical classification system was used to assess the sentiment, media format, perspective, timing, accuracy, and general content of each post. Post popularity was measured by number of likes and comments. Results: A total of 3119 Instagram posts and 267 Twitter posts were included in the analysis. Of the 3119 Instagram posts analyzed, 34% were from patients, and 28% were from providers. Of the 267 Twitter posts analyzed, 42% were from patients, and 16% were from providers. Although the majority of social media posts were of a positive sentiment, over the past 3 years, there was a major surge in negative sentiment posts (97% increase) versus positive sentiment posts (9% increase). Patients were more likely to focus their posts on rehabilitation, return to play, and activities of daily living. Providers tended to focus their posts on education, rehabilitation, and injury prevention. Patient posts declined over the past 3 years (–28%), whereas provider posts increased substantially (110%). Of posts shared by health care providers, 4% of posts contained inaccurate or misleading information. Conclusion: The majority of patients who post about their UCL injury and reconstruction on social media have a positive sentiment when discussing their procedure. However, negative sentiment posts have increased significantly over the past 3 years. Patient content revolves around rehabilitation and return to play. Although patient posts have declined over the past 3 years, provider posts have increased substantially with an emphasis on education.

Sign in / Sign up

Export Citation Format

Share Document