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Medial Ulnar Collateral Ligament Injury
Posted: Nov 8 2020 #(C101622)
A

Medial Ulnar Collateral Ligament Rupture in 20M

HPI

A 20-year-old collegiate outfielder presents to you with medial sided elbow pain following a throw from the outfield fence where he felt a pop. He completed some therapy sessions guided by the team trainers and now his elbow pain only bothers him while throwing more than 100ft. He hasn't had any issues with the elbow prior to this injury nor has he had any injections.

PMH

He has an ACL reconstruction with a meniscal repair 2 years prior with an unremarkable recovery. He bats and throws right-handed, and has sophomore collegiate eligibility remaining.

PE

Patient is 6'4 and 210lbs. His elbow ranges from 4 degrees short of full extension to 140 degrees of flexion, and he has full prono-supination There is tenderness over the medial elbow at the sublime tubercle but no pain with resisted wrist flexion. Pain in medial elbow with the moving milking maneuver but no obvious opening with valgus stress.

Poll
1 of 8
1. In addition to plain film radiographs, would you obtain any other imaging studies to guide management?
No - current radiographs are sufficient
10%
72/705
Yes- additional radiographic views (XR) (includes stress views)
4%
31/705
Yes - CT scan of the elbow (CT)
1%
13/705
Yes - MRI of the elbow (MRI)
67%
475/705
Yes - XR + CT
0%
5/705
Yes - XR + MRI
9%
65/705
Yes - CT + MRI
1%
14/705
Yes - XR + CT + MRI
1%
10/705
Outside my area of expertise - best if I don't vote
2%
20/705
2. How would you manage this injury?
Nonoperative
31%
216/682
Operative
60%
410/682
Outside my area of expertise - best if I don't vote
8%
56/682
3. If you choose Operative management, how would you treat the medial ulnar collateral ligament injury (MUCL)?
I would not choose Operative management
8%
54/647
MUCL Repair
27%
175/647
MUCL Reconstruction
54%
351/647
Outside my area of expertise - best if I don't vote
10%
67/647
4. If you choose MUCL Reconstruction, what type of graft would you use?
I would not choose MUCL Reconstruction
6%
40/602
Ipsilateral palmaris longus autograft
52%
314/602
Contralateral palmaris longus autograft
6%
42/602
Ipsilateral hamstring autograft
6%
38/602
Contralateral hamstring autograft
2%
18/602
Other autograft
0%
2/602
Allograft
7%
46/602
Suture only (e.g. Internal Brace)
4%
30/602
Outside my area of expertise - best if I don't vote
11%
72/602
5. If you choose MUCL Reconstruction, which technique would you use?
I would not choose MUCL Reconstruction
5%
29/535
Traditional Jobe technique (Figure-of-8 with two connected bone tunnels in medial epicondyle)
8%
45/535
Modified Jobe technique (More anterior medial epicondyle tunnels to avoid ulnar nerve irritation)
23%
127/535
Docking technique (Single bone tunnel in medial epicondyle)
22%
123/535
Hybrid interference-screw technique
13%
74/535
Other
1%
6/535
Outside my area of expertise - best if I don't vote
24%
131/535
6. If you choose Operative management, how would you manage the ulnar nerve?
I would not choose Operative management
4%
23/514
In situ ulnar nerve decompression only
44%
231/514
Subcutaneous ulnar nerve transposition
15%
82/514
Subfascial ulnar nerve transposition
12%
64/514
Submusclar ulnar nerve transposiiton
7%
41/514
Other
2%
12/514
Outside my area of expertise - best if I don't vote
11%
61/514
7. If you choose MUCL Reconstruction, when would you initiate a progressive throwing program post-operatively?
I would not choose MUCL Reconstruction
2%
14/500
<1 month
4%
20/500
1-2 months
14%
72/500
3-4 months
36%
181/500
5-6 months
22%
111/500
7-9 months
6%
31/500
>9 months
5%
25/500
Outside my area of expertise - best if I don't vote
9%
46/500
8. If you choose MUCL Reconstruction, when would you allow the patient to return to competitive throwing?
I would not choose MUCL Reconstruction
2%
14/495
<3 months
0%
0/495
3-6 months
18%
94/495
7-9 months
35%
178/495
10-12 months
26%
133/495
13-16 months
6%
32/495
>16 months
0%
4/495
Outside my area of expertise - best if I don't vote
8%
40/495
PROCEDURE #1

Right elbow medial UCL reconstruction using ipsilateral palmaris longus graft.

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