Review Question - QID 4446

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Medial Ulnar Collateral Ligament Injury Treatment Nonoperative QID: 4446 (OBQ12.86)

QID 4446 (Type "4446" in App Search)

A 19-year-old male complained of right elbow pain 4 months ago after pitching in a collegiate baseball game. He underwent a period of rest and forearm strengthening and now has recurrence of pain during a throwing interval program. A MRI is shown in Figure A. What is the next most appropriate step in management?

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Open ECRB tendon release and removal of the diseased tendon with repair of the tendon remnant

205/6443

Arthroscopic debridement of lesion and osteotochondral autograft transplant from ipsilateral knee

148/6443

Excision of the diseased tendon and reattachment of the origin of the flexor-pronator muscle group to the medial epicondyle

433/6443

Open reconstruction of the ligament using ipsilateral palmaris longus tendon

83%

5331/6443

Diagnostic elbow arthroscopy, removal of posteromedial olecranon osteophytes and débridement of chondromalacia

275/6443

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Open reconstruction of the medial (ulnar) collateral ligament using ipsilateral palmaris longus tendon is indicated in medial collateral ligament injuries in high level overhand throwing athletes with symptoms recalcitrant to conservative management.

Conservative treatment of medial (ulnar) collateral ligament injuries in over-hand throwing athletes includes a period of rest from throwing followed by a flexor-pronator mass strengthening regimen. Next, the patient participates in a progressive throwing interval program.

Rettig et al. performed a Level 4 review of 31 throwing athletes with ulnar collateral ligament injuries that were treated in a nonoperatively with a minimum of 3 months rest. They found that 42% of the athletes were able to return to sport after an average of 6 months of rest, forearm strengthening, and throwing interval program.

Davidson et al. present data from a cadaveric dissection study of 11 elbows. They found that the flexor carpi ulnaris (FCU) muscle and flexor digitorum superficialis (FDS)muscle, provide medial elbow support to the medial (ulnar) collateral ligament.

Figure A is a T2 coronal MRI of the right elbow that demonstrates a ruptured medial (ulnar) collateral ligament off of the ulna.

Incorrect Answers:
Answer 1: This would be a reasonable method of management for recalcitrant ECRB tendonitis.
Answer 2: This would be a reasonable method of management for an osteochondral defect.
Answer 3: This would be a reasonable method of management for recalcitrant flexor-pronator tendonitis.
Answer 5: This would be a reasonable method of management for valgus extension overload syndrome.