UCL Tears

 

 

When evaluating a suspected UCL sprain the practitioner should begin with the patient’s history. The history should straight forward without the practitioner leading into potential answers for the patient.

 

• Start off with mechanism of injury, what the patient did to injury themselves?  Most commonly the mechanism of injury for a UCL sprain is putting the elbow in a vulnerable position which places a valgus stress onto the elbow, such as throwing a baseball or falling onto an outstretched arm.

 

• When did the injury take occur? UCL injuries are primarily acute injuries that cause immediate onset of pain. Find out what kind of lifestyle the patient lives, such as activity level and career. A high activity level patient’s stating they play baseball are at a higher risk than someone who is less physically active and works a desk job.  

 

• Has the patient had any previous injuries/surgeries to their elbow?

 

• Ask them about their pain. There are many formats for grading one’s pain, the quickest and perhaps easiest would be using scale 0-10. Make sure to explain the pain scale so patients have an accurate understanding of the different levels of pain. Ask the patient to describe the type of pain (sharp, throbbing, achy, numbness/tingling, etc.). UCL injuries present with a sharp pain over the medial aspect of the elbow and can radiate distally down the forearm. Numbness and tingling may also be present in the medial aspect of the forearm moving distally into the 4th and 5th metacarpals and digits.

 

• What makes the pain worse? Activities that elicit pain when the elbow is forced into a valgus position is a sign of injury to the UCL.

 

• What makes the pain better?

 

• Is the patient currently taking any medications for or non-relating to the injury?

 

After getting a basis for the patient’s history, it is the practitioners judgment if further subjective evaluation is needed based on each patients’ uniqueness.

The physical examination will display: 

 

• Point-tenderness and ecchymosis over the medial aspect of the humeral-ulnar joint upon palpation.

• Bilateral comparison can distinguish if the patient is predisposed to UCL injuries due to an over valgus carrying angle.

• Commonly there will be swelling over the effected area.

• A valgus stress test is an accurate way of diagnosing a UCL injury. With this test the elbow is forced medially, generally the ulnar collateral ligament limits the elbow moving medial. If the ulnar collateral ligament is torn the practitioner will experience laxity of the joint along with no apparent end-feel accompanying pain.

 

Following the physical examination if UCL sprain is suspected the patient should be referred to a physician for further evaluation and diagnostic testing.

 

Magnetic Resonance Imaging (MRI) would be the scan of choice to clearly identify a sprain to the UCL and accurately diagnose the grade of the sprain.