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Medial Collateral Ligament Injury
Injury to the elbow medial ulnar
collateral ligament (MUCL) from
valgus (medial-directed) forces
was first described in a javelin
thrower in 1946 by Waris. The
injury then became well
recognized in overhead throwing
athletes and most commonly in
baseball pitchers. Accurate
diagnosis is based on a history
of medial elbow pain during the
acceleration phase of throwing.
Chronic injuries present
gradually and often with pain
present, only when throwing
greater than 50-75% of maximal
effort. Acute injuries may
present suddenly with a pop,
sharp pain, and inability to
continue throwing. Tenderness
directly over the MUCL, and
valgus instability after applied
stress, both indicate a possible
MUCL injury. Imaging studies
confirm the diagnosis. Valgus
stress radiographs may be used
to document excessive medial
joint line opening. An opening
greater than 3mm has been
considered diagnostic of valgus
instability. A conventional MRI
can identify thickening within
the ligament or full thickness
tears. MR arthrography enhanced
with intra-articular gadolinium
improves the diagnosis of
partial undersurface tears.
Patients who wish to continue throwing, have
failed non-operative treatment, have an accurate diagnosis, and are willing to
participate in the lengthy rehabilitation are indicated for surgical
reconstruction. Certain career and timing situations may favor reconstruction
without demonstrating failed non-operative treatment. Relative
contra-indications to surgical reconstruction include inability to participate
in lengthy rehabilitation and poor patient motivation.
For more information, please see
the following articles on other
common elbow conditions:
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