Review Question - QID 217443

Lateral Ulnar Collateral Ligament Injury (PLRI) QID: 217443 (OBQ21.124)

QID 217443 (Type "217443" in App Search)

A 42-year-old male presents to the ED following a posterolateral elbow dislocation after a snowboarding accident. His elbow is reduced in the ED and post-reduction imaging reveals no fracture. Two weeks later, he complains of difficulty pushing up out of a chair. On examination, with the patient laying supine and the affected arm placed overhead, he reports pain and clunking when the forearm is supinated and a valgus stress is applied while bringing the elbow from full extension to 40 degrees of flexion. Which of the following ligaments in Figure A is the primary stabilizer to varus and external rotation stress of the elbow that is deficient in this patient?

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138/2003

23/2003

30/2003

111/2003

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1685/2003

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This patient sustained a lateral ulnar collateral ligament (LUCL) injury following an elbow dislocation. The LUCL is the primary stabilizer to varus and external rotation stress of the elbow.

LUCL injury is a ligamentous elbow injury that usually is associated with a traumatic elbow dislocation and characterized by posterolateral subluxation or dislocation of the radiocapitellar and ulnohumeral joints. Diagnosis can be made with plain radiographs of the elbow which may show an isolated elbow dislocation or an elbow dislocation with a radial head and coronoid tip fracture. Treatment may be nonoperative or operative depending on presence of concomitant elbow fractures, as well as elbow stability following reduction.

Daluiski et al. reviewed acute elbow injuries that disrupt the LUCL and result in PLRI. They reported no significant difference in clinical outcome or range of motion after direct repair of traumatic tears of the LCUL tear between acute and delayed treatment cohorts. They concluded that despite complete disruption of the posterolateral ligaments, direct repair of the torn ligament to its humeral origin was effective without supplemental tendon graft reconstruction irrespective of interval from injury to repair, mechanism of injury, or associated fractures.

Camp et al. reviewed reconstruction of the LUCL for recurrent symptomatic PLRI. They reported on the use of the docking technique which passes the graft through a tunnel on the ulnar side and the 2 free limbs are docked into the humerus at the isometric point on the lateral condyle. They noted the advantages of this method of reconstruction include reduced bone removal, decreased soft tissue damage, and precise control of graft tensioning. They concluded that this technique can be performed in a reliable, efficient, and reproducible manner for patients with PLRI of the elbow.

Anakwenze et al. reviewed symptomatic PLRI. They reported that symptoms and examination characteristics are subtle and can be easily misdiagnosed.They concluded that symptomatic cases of PLRI can be effectively treated with a repair or isometric ligament reconstruction.

Figure A is the unlabeled lateral ligaments of the elbow. Illustration A is the corresponding lateral ligaments of the elbow.

Incorrect Answers:
Answer 1: This is the radial collateral ligament
Answer 2: This is the annular ligament
Answer 3: This is the accessory collateral ligament
Answer 4: This is the articular capsule