Assessing a Novel Method of Providing Valgus Stress During Ultrasound Examination of the Ulnar Collateral Ligament

PM&R ◽  
2015 ◽  
Vol 7 ◽  
pp. S88-S88 ◽  
Author(s):  
Luga Podesta ◽  
Alexander Ghatan ◽  
Russell LaFrance
Keyword(s):  
Ultrasound Examination ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Novel Method

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.

Comparison of the Biomechanical Profile of the Intact Ulnar Collateral Ligament with the Modified Jobe and the Docking Reconstructed Elbow

2009 ◽  
Vol 37 (5) ◽  
pp. 974-981 ◽  
Author(s):  
Michael G. Ciccotti ◽  
Sorin Siegler ◽  
John A. Kuri ◽  
John H. Thinnes ◽  
Daniel J. Murphy
Keyword(s):  
Degrees Of Freedom ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Anterior Portion ◽  
Reconstructive Procedures ◽  
Kinematic Coupling ◽  
Loading System ◽  
4 Degrees Of Freedom

Background The modified Jobe and Docking techniques are commonly used to reconstruct the elbow's ulnar collateral ligament. Hypothesis Valgus laxity and kinematic coupling after these reconstructive procedures are similar to those of the native ulnar collateral ligament. Study Design Controlled laboratory study. Methods Testing was conducted on 10 pairs of cadaver elbows using a 4 degrees of freedom loading system. Subfailure valgus loads were applied to the native elbows at different flexion angles; motion and ligament elongation were measured. The elbows were then loaded to failure in valgus at 90° of flexion. The reconstructive techniques were then applied and testing was repeated. Results Only the resting length of the anterior portion of the ulnar collateral ligament anterior bundle remained isometric throughout range of motion. Valgus laxity was nearly equal for the native and reconstructed ligaments at flexion angles of 90° or higher. However, both reconstructions provided less valgus stability than the native ulnar collateral ligament at low flexion angles. Kinematic coupling decreased with increased flexion for both native and reconstructed ligaments. Conclusion The modified Jobe and Docking techniques reconstruct restraint of the native ulnar collateral ligament to valgus laxity and kinematic coupling at 90° of flexion and higher angles where peak valgus torque is experienced in the throwing elbow. Clinical Relevance Both reconstructions provide valgus stability comparable to that of the native ulnar collateral ligament at 90° and higher, helping to explain their success in treating throwing athletes. Both reconstructions provide less valgus stability than the native ulnar collateral ligament at low flexion angles, suggesting that patients undergoing ulnar collateral ligament reconstruction should be cautioned against activities that provide valgus stress at low elbow flexion angles, such as side-arm throwing. This study suggests caution against overtightening the reconstructions at the common 30° of flexion.

Diagnosis by Ultrasound of Dislocated Ulnar Collateral Ligament of the Thumb

1995 ◽  
Vol 36 (4-6) ◽  
pp. 620-625 ◽  
Author(s):  
M. Höglund ◽  
P. Tordai ◽  
C. Muren
Keyword(s):  
Surgical Repair ◽  
Ultrasound Examination ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Severe Lesion

The ability of ultrasound to assess a displaced ulnar collateral ligament of the 1st metacarpo-phalangeal (MCP) joint was evaluated. If the ligament is ruptured and displaced proximal to the adductor aponeurosis, a surgical repair should be undertaken to restore stability. Ultrasound accurately diagnosed these lesions in 32/39 operated patients. In 4 cases the ultrasound examination suggested a more severe lesion than was found at operation. In 3 cases a lesser injury was suspected than later proved to be present.

scholarly journals Elbow valgus stability of the transverse bundle of the ulnar collateral ligament

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Hirotake Yokota ◽  
Ryo Hirabayashi ◽  
Chie Sekine ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Load Condition ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Limb Position ◽  
Intact State ◽  
Significant Difference ◽  
Telos Stress Device

Abstract Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.

Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics

Hand ◽  
2019 ◽  
pp. 155894471986851
Author(s):  
Charles C. Lin ◽  
Nilay A. Patel ◽  
Yasuo Itami ◽  
Michelle H. McGarry ◽  
Steven S. Shin ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Biomechanical Analysis ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Ligament Tear ◽  
Partial Tear ◽  
Complete Tear ◽  
Valgus Instability ◽  
The Stability

Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at −10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact ( P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion ( P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion ( P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.

scholarly journals Changes in Medial Elbow Joint Space When Elbow Valgus Stress Is Applied at Different Limb Positions and Loads In Vivo

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110459
Author(s):  
Kanta Yoshioka ◽  
Kanta Matsuzawa ◽  
Tomoya Ikuta ◽  
Sae Maruyama ◽  
Mutsuaki Edama
Keyword(s):  
Repeated Measures ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Sports Injury ◽  
Joint Space ◽  
Muscle Contractions ◽  
Collateral Ligament ◽  
Valgus Stress

Background: Ulnar collateral ligament (UCL) injury is a common sports injury among overhead-throwing athletes and causes medial elbow pain and instability. UCL injury is generally diagnosed based on symptoms, physical findings, and image evaluation. To standardize the method for evaluating elbow valgus instability, more information is needed regarding changes in the medial elbow joint space (JS) in healthy elbows. Purpose/Hypothesis: The purpose of this study was to measure the JS during the application of elbow valgus stress at different elbow flexion angles and loads and to clarify the presence of defensive muscle contractions during elbow valgus stress. It was hypothesized that the JS will differ according to different limb positions and loads and that defensive contractions will occur when elbow valgus stress is >90 N. Study Design: Controlled laboratory study. Methods: Elbow joints on the nondominant side were examined in 20 healthy male university students (mean age, 21 ± 0.2 years) at 30°, 60°, and 90° of elbow flexion. To create valgus stress on the elbow, loads of 30, 60, 90, 120, and 150 N were applied with a Telos stress device and with gravity stress on the forearm. The medial JS was measured ultrasonographically during the application of elbow valgus stress. Electrodes were attached to the pronator teres muscle, and defensive muscle contractions were measured using electromyography during the application of elbow valgus stress. Repeated-measures analysis of variance and paired t tests were used to compare the JS at each elbow angle and each valgus stress load, and the Bonferroni method was used as a post hoc test. Results: At 30° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 or 30 N ( P ≤ .018 for all). At 60° of flexion, the JS was significantly higher at 30 N versus 0 N, at 60 N versus 0 and 30 N, and at 90 N versus 0, 30, and 60 N ( P ≤ .024 for all). At 90° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 and 30 N ( P ≤ .028 for all). Defensive muscle contraction did not occur at any elbow flexion angles at elbow valgus stress ≤60 N. Conclusion: The lack of muscular contraction at elbow valgus stress ≤60 N may reflect the function of the medial collateral ligament. Clinical Relevance: Elbow valgus stress ≤60 N allows for the evaluation of the joint opening.

scholarly journals Valgus Stability is Enhanced by Flexor Digitorum Superficialis Muscle Contraction of the Index and Middle Fingers

2020 ◽  
Author(s):  
Shota Hoshika ◽  
Akimoto Nimura ◽  
Norimasa Takahashi ◽  
Hiroyuki Sugaya ◽  
Keiichi Akita
Keyword(s):  
Muscle Contraction ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
The Difference ◽  
Flexor Digitorum ◽  
Healthy Males

Abstract Background: Flexor digitorum superficialis (FDS) muscle provides dynamic stabilization and medial elbow support for ulnar collateral ligament (UCL). The FDS contraction significantly affects the medial joint distance (MJD) through grip contraction. However, it remains unclear whether FDS activity alone contributes to medial elbow stability, or together with the activation of the flexor digitorum profundus during grip contraction, and which finger’s FDS is the main contributor to elbow stability. We investigated the resistive effects of isolated FDS contraction in individual fingers against valgus stress in the elbow joint using stress ultrasonography (US).Methods: We investigated 17 healthy males (mean age, 27 ± 5 years). Valgus stress US was performed using the Telos device, with the elbow at 30° flexion. MJD was measured for each arm during 3 separate conditions: at rest (unloaded), under valgus load (50 N) (loaded), and under valgus load with FDS contracted in individual fingers (loaded-contracted). Results: MJD was significantly longer when loaded (5.4 ± 0.4 mm) than unloaded (4.1 ± 0.2 mm, P = .007) or loaded-contracted (4.6 ± 0.3 mm, P = .003) for each finger. When loaded-contracted, MJD differed statistically between the index and ring fingers (P = .03) and between the middle and ring fingers (P = .04). However, the difference between the index and middle fingers was not statistically significant (P = .08).  Conclusions: Individual FDS contraction, particularly of the index and middle fingers contributes most to stabilization against valgus stress. Thus, injury care programs should incorporate FDS exercises of these fingers.

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