Review Question - QID 219446

This patient likely sustained iatrogenic injury to the lateral ulnar collateral ligament of the elbow. The LUCL is the primary stabilizer to varus & external rotation stress.

Lateral epicondylitis (also known as tennis elbow) is an overuse injury caused by eccentric overload at the origin of the common extensor tendon, leading to tendinosis and inflammation of the ECRB. Diagnosis is made clinically with tenderness over the lateral epicondyle made worse with resisted wrist extension. Treatment is primarily nonoperative with NSAIDs, activity modification, and bracing. Rarely, operative management is indicated for patients with persistent symptoms who fail nonoperative management. One complication with surgical management of this condition is injury to the lateral ulnar collateral ligament (LUCL). This may result for excessive resection of the LUCL. Surgical exposure should not extend beyond the equator of the radial head. Injury to the LUCL may lead to posterolateral rotatory instability (PLRI).

Calfee et al. reviewed lateral epicondylitis. They reported that nonsurgical treatment is the mainstay of management and involves rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities. They noted that for patients with recalcitrant disease, surgical management may be indicated. They concluded that care must be taken not to injury the LUCL.

Pomerantz et al. reported on the complication rates for lateral epicondylitis. They reported that the overall complication rate was 3.3%. They concluded that for open procedures, it was 4.3%, percutaneous procedures 1.9%, and arthroscopic procedures 1.1%.

Schneider et al. reviewed the clinical outcomes of LUCL reconstruction using a triceps tendon graft after failed open lateral epicondylitis surgery. They reported that LUCL reconstruction in patients with PLRI after release of the common extensor origin can restore elbow stability and achieve high patient satisfaction. They concluded that outcome scores and revision rates in this cohort were inferior to published outcomes of primary LUCL reconstruction for the treatment of non-iatrogenic or traumatic PLRI.

Illustration A is the lateral ligaments of the elbow.

Incorrect Answers:
Answers 1,2,3,5: The LUCL is the primary stabilizer to varus & external rotation stress of the elbow.