Introduction
- In flexion :
- MCL provides 54% of valgus stability
- Osseous articulation provides 33% of valgus stability
- Capsule provides 10% of valgus stability
- Flexor-pronator mass provides dynamic support
- When MCL is intact, radial head can be resected with no effect on valgus instability
- With an intact radial head, section of the MCL gives only minor instability
- Section of the MCL and resection of the radial head results in gross instability
- Seen in repititive valgus stress, like throwing movements
- Causes attenuation and failure of MCL, esp. the anterior bundle
- Presents with diminshed sport functionality or medial elbow pain
Anatomy
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Pathogenesis
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Natural History
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Patient History and Physical Findings
History:
Physical Findings:
- In the setting of an elbow dislocation that has undergone a closed reduction it is imperative to test and document stability in all planes with the forearm in pronation, neutral, and supination. This will help guide treatment and rehabilitation.
- Ulnar nerve symptoms may be seen
- May have medial epicondyle tenderness, but only 50% show instability on examination
- Diagnosis of valgus instability : Gravity stress X-Ray
- Patient supine, shoulder in ER, elbow flexed to 30°
- If unstable the medial ulnohumeral joint will open up with gravity stress, which means rupture of the MCL and flexor-pronator mass
Imaging and Diagnostic Studies
Radiography:
MRI and CT Myelogram demonstrate the lesion clearly
Differential Diagnosis
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Treatment
- Conservative management
- Chronic unresponsive cases or high level athletes can be treated by reconstruction, using palmaris longus tendon
- If ulnar nerve symptoms coexist and there is no response to conservative management or reconstructive measures, transpose the nerve
Pearls and Pitfalls
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Postoperative Care
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Outcome
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Complications
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