Medial Instability of the Elbow

Hyoung Seok Jung; Min Jong Park

doi:10.12790/ahm.2018.23.2.78

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Jung and Park: Medial Instability of the Elbow

Review Article

Arch Hand Microsurg 2018;23(2):78-86.

Published online: 5 January 2018

DOI: https://doi.org/10.12790/ahm.2018.23.2.78

Medial Instability of the Elbow

Hyoung Seok Jung¹, Min Jong Park²

¹Department of Orthopedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea

²Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Min Jong Park Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea TEL: +82-2-3410-3506, FAX: +82-2-3410-0061, E-mail: mjp3506@skku.edu

Received 11 May 201815 May 2018 Accepted 15 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Medial elbow instability has been a debilitating problem for the athlete performing overhead throwing and the increase in the number of participants in throwing sports has brought increase in its incidence in non-athletes. Instability can occur as a result of a single traumatic event, but, in most cases, it develops as a result of repetitive micro-trauma over a long period of time. During the overhead throwing, tensile force is applied to the medial stabilizing structures and compressive force is applied to the lateral structures. Common injuries encountered in the throwing elbow include medial collateral ligament tear, ulnar nerve neuropathy, flexor-pronator tendinitis or tear and valgus extension overload syndrome. Knowledge of the anatomy and biomechanics of the elbow joint, along with an understanding of throwing mechanism, is necessary to properly diagnose and treat the throwing athlete. The purpose of this article is to review the functional anatomy of medial elbow stabilizing structure, pathophysiology of medial elbow instability and its diagnostic method and treatment option including reconstruction of medial collateral ligament.

Keywords: Medial elbow instability, Medial collateral ligament, Ulnar nerve

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Fig.1.

(A) Anatomy of the medial collateral ligament. (B) The anterior band is the most important structure for valgus stability. Cited from the Park MJ. Hand and Upper Extremity Surgery: The Wrist and Elbow. Seoul: Panmun; 2017.

Fig.2.

The 6 phases of the overhead thrwoing motion. Cited from the Park MJ. Hand and Upper Extremity Surgery: The Wrist and Elbow. Seoul: Panmun; 2017.

Fig.3.

(A) Valgus stress test. (B) Moving valgus stress test.

Fig.4.

Schematic of medial collateral ligament reconstruction with figure of 8 technique (A) and docking technique (B). Cited from the Park MJ. Hand and Upper Extremity Surgery: The Wrist and Elbow. Seoul: Panmun; 2017.

Table1.

Summary of studies of medial collateral ligament reconstruction

Author	Year (yr)	Sport	Number	Mean age (yr)	Surgical approach	Fixation method	Ulnar nerve transposition	Rate of return to play (%)	Rate of postoperative ulnar neuropathy (%)	) Mean follow-up (yr)
Jobe et al.¹⁸	1986	Baseball, javelin	16	25.3	FPM detachment	Figure of 8	Yes (SM)	63	31.3	4.3
Azar et al.²⁵	2000	Baseball, football, wrestling, tennis	59	21.6	FPM retraction	Figure of 8	Yes (SC)	81	1.7	2.95
Thompson et al.²⁶	2001	Baseball, javelin, football, platform diver, softball	33	24.3	FPM muscle split	Figure of 8	No	82	4.8	3.1
Rohrbough et al.²¹	2002	Baseball, lacrosse, tennis, golf	36	23	FPM muscle split	Docking	No	92	2.8	3.3
Koh et al.²⁷	2006	Baseball	19	21.7	FPM muscle split	Modified docking (3 strand)	No	95	5.3	3.5
Paletta and Wright²⁸	2006	Baseball	25	24.5	FPM muscle split	Modified docking (4 strand)	No	92	4	2.5
Dines et al.²²	2007	Baseball, football, hockey	22	20.1	FPM muscle split	DANE TJ	No	86	9.1	3
Bowers et al.²⁹	2010	Baseball	21	20	FPM muscle split	Modified docking (3 strand)	No	90	0	2.3
Dugas et al.³⁰	2012	Baseball	120	21.7	FPM retraction	Figure of 8	Yes (SC)	88	20.8	2.8
Savoie et al.³¹	2013	Baseball, softball, javelin	116	20.4	FPM muscle split	Multiple technique Ulnar : bone tunnel or interference screw, Humerus : docking or figure of 8	No	83	2.6	3.25
Jones et al.³²	2014	Baseball, javelin, gymnastics	55	17.6	FPM muscle split	Docking	No	87	7.3	2.6

FPM: flexor-pronator mass, SM: submuscular, SC: subcutaneous.

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