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Sonography of injury of the ulnar collateral ligament of the elbow—initial experience

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Abstract

Objective

The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow.

Design and patients

Eight non-professional male baseball pitchers, ages 13–35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months.

Results

In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment.

Conclusion

Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology.

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Acknowledgements

We would like to thank Dr. Karen Finlay of the Department of Radiology, Hamilton Health Sciences—Henderson Division, and Mr. Jag Dhanju of the Canadian Centre for Musculoskeletal Ultrasound, Toronto, Canada for contributing one of the cases.

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Authors and Affiliations

  1. Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, Great Neck, NY, 11021, USA

    Theodore T. Miller

  2. Department of Imaging and Nuclear Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Ronald S. Adler

  3. Department of Radiology, Hamilton Health Sciences—Henderson Division, 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada

    Lawrence Friedman

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  1. Theodore T. Miller
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  2. Ronald S. Adler
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  3. Lawrence Friedman
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Correspondence to Theodore T. Miller.

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Miller, T.T., Adler, R.S. & Friedman, L. Sonography of injury of the ulnar collateral ligament of the elbow—initial experience. Skeletal Radiol 33, 386–391 (2004). https://doi.org/10.1007/s00256-004-0788-4

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  • DOI: https://doi.org/10.1007/s00256-004-0788-4

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