Korean J Sports Med.  2017 Sep;35(2):125-130. 10.5763/kjsm.2017.35.2.125.

Ulnar Collateral Ligament Tear Combined with Medial Epicondylitis of the Elbow

• Ku JH
• Cho HL
• Jin HK
• Kim JU

• KMID: 2389653
• DOI: http://doi.org/10.5763/kjsm.2017.35.2.125

Abstract

Medial epicondylitis, also known as "golfer's elbow," is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.

Keyword

Medial epicondylitis; Ulnar collateral ligament; Ulnar collateral ligament reconstruction

MeSH Terms

Collateral Ligaments*
Cumulative Trauma Disorders
Elbow*
Magnetic Resonance Imaging
Physical Examination
Tears*
Tendons

Figure

• 

  Fig. 1 Patient 1. (A) Photograph of right elbow shows focal swelling (white arrow) in medial epicondylar region. (B) Anteroposterior plain radiograph shows sclerosis of medial epicondylar margin. Bilateral gravity valgus stress long axis sonographic images in (C) injured and (D) uninjured elbow show focal hypoechoic focus (asterisk) corresponding to the tears of pronator-flexor muscles and ulnar collateral ligament, and increased ulnohumeral distance (d) in injured elbow. U: ulna, H: humerus.

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  Fig. 2 Magnetic resonance imaging of right elbow in patient 1. (A) Coronal T2-weighted fast spin echo image of the elbow shows complete tear of flexor-pronator tendon (asterisk) and humeral origin of ulnar collateral ligament (white arrow). Also note marked extravasation of high signal intensity joint effusion. (B) Axial T2-weighted fast spin-echo image of the elbow shows abnormal high signal intensity joint effusion and tear of posterior band of ulnar collateral ligament and joint capsule (white arrow).

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  Fig. 3 Operative photographs of patient 1. (A) Complete tear of flexor muscle and marked proliferation of pinkish granulation tissue. (B) Harvesting of ipsilateral palmaris longus tendon. (C) Tendon graft passage through ulnar tunnel. (D) Tensioning of graft in humeral tunnel with docking technique. (E) Suture anchor repair of pronator and common flexor tendon. (F) Final construct of repair.

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  Fig. 4 Patient 2. (A) Photograph of left elbow shows focal swelling (white arrow) in medial epicondylar region. (B) Anteroposterior plain radiograph shows no significant abnormal findings. Bilateral gravity valgus stress long axis sonographic images in (B) injured and (C) uninjured elbow show focal hypoechoic focus (asterisk) corresponding to the tears of pronator-flexor muscles and ulnar collateral ligament, and increased ulnohumeral distance (d) in injured elbow. U: ulna, H: humerus.

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  Fig. 5 Magnetic resonance imaging of left elbow in patient 2. (A) Coronal T2-weighted image of the elbow shows complete tear of flexor-pronator tendon (asterisk) and humeral origin of ulnar collateral ligament (white arrow). (B) Axial T2-weighted image shows maintained posterior band of ulnar collateral ligament and joint capsule (white arrow).

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