Medial Collateral Ligament Injuries in the Overhead Athletes

Abstract

The diagnosis and treatment of medial ulnar collateral ligament (MUCL) injuries is becoming increasingly more common in overhead athletes such as baseball pitchers, particularly in younger athletes. The mechanism is most commonly repetitive valgus loading of the medial structures of the elbow during the throwing motion. Our understanding of the anatomy and biomechanics of the medial elbow structures has increased over the last several decades. An important distinction must be made from other disorders that may present on the medial elbow including valgus extension overload syndrome, flexor-pronator muscle ruptures, medial epicondylitis, and ulnar neuritis. A careful clinical exam can usually lead to an accurate diagnosis. Various imaging studies may be used to aid in the diagnosis including radiographs, magnetic resonance imaging, and stress ultrasound. Accurate diagnosis is important to address all pathology at the time of the operation and avoid complications. Operative treatment is indicated in the overhead throwing athlete with inadequate resolution of symptoms after conservative treatment and rehabilitation. There are various surgical techniques for reconstruction. No one technique has demonstrated superiority, and athletes can experience a high rate of return to play after ligament reconstruction.