Medial collateral ligament injury elbow
Ulnar collateral injury

There are several ligaments around the elbow that provide stability to the joint. An injury to the medial collateral ligament of the elbow is characterised by pain and a feeling of instability on the inside of the elbow.

Pain on the inside of the elbow occurs regularly. The symptoms can mainly develop in extreme positions of the elbow. Injury to the medial collateral ligament is therefore often seen in people who practise sports involving (overhead) throwing.

Description of the condition

The elbow contains two joints that together form the elbow joint. Thanks to these two joints the elbow can bend and extend and we can rotate our forearm. The forearm contains two bones; the ulna and the radius. The medial collateral ligament of the elbow connects the bone of the upper arm to the ulna.

Various structures around the elbow provide stability and control to the joint during movement. The stability of the elbow joint is 50% obtained from the bony structures themselves. The remaining stability is provided by the joint capsule, the medial collateral ligament and the lateral collateral ligament.

The medial collateral ligament is also called the ulnar collateral ligament by medics. The ligament consists of 3 smaller bundles that provide lateral stability to the inside of the elbow. The ligament mainly provides stability during throwing movements or other overhead sporting activities.

Pain develops on the inside of the elbow particularly if the medial collateral ligament is strained too often or too severely. For this reason, the injury is sometimes referred to as the overload syndrome of the elbow.

Cause and origin

A medial collateral ligament injury is often the result of repeated overhead throwing. The injury is therefore typical for baseball players, but also occurs in other overhead sports. For example, in tennis, softball and handball.

Incorrect technique, reduced flexibility and training progression that is too fast are the main causes of strain to the inside of the elbow.

The bony structures of the joint between the upper arm and the ulna only provide stability during a small portion of movement. Namely, only around the end-of-range positions, between 0 and 20 degrees, and above 120 degrees during flexion of the elbow. While throwing with the right technique, the elbow is usually bent 100 degrees, so that much of the stability must come from the ligaments and muscles.

By throwing frequently, laxity (weakness) of the ligament can develop which gives instability in the elbow joint. Also, when the elbow is extended in the last phase of the throw, enormous forces are exerted on the inside and the rear of the elbow.

Laxity of the medial collateral ligament and not acting properly can cause wedging of tissue on the backside of the elbow. This is called an impingement.

Complaints on the inside of the elbow can develop either gradually or acutely. If the symptoms are acute, a snap is usually felt in the elbow. This is immediately followed by a lot of pain and it is no longer possible to continue playing sports.

Signs & symptoms

The main symptom is pain on the inside of the elbow. In addition, overhead athletes often have symptoms during a certain trajectory of an overhead movement. For example, while throwing or serving in tennis.

After a prolonged period of instability, pain can also occur when extending the elbow. This pain is then often experienced as very painful and sharp and is usually caused by the so-called impingement.

Besides pain, swelling and discolouration can occur on the inside of the elbow. Swelling and discolouration are particularly evident in acute injuries. Athletes also often notice a loss of coordination or strength during specific movements.

Diagnosis

The physiotherapist makes the diagnosis based on an interview and a physical examination. The physical examination is mainly aimed at checking whether there is instability of the joint ligaments on the inside of the elbow.

In the case of an acute injury or extreme laxity, medical imaging is usually performed to see if there is a tear or other problem in the elbow.

Treatment

Initially, the treatment consists of rest to allow the ligament to recover. Subsequently, the capacity of the elbow will be increased using exercise therapy.

In addition, the correct technique is examined. This can be improved by functional training. This functional training forms a gradual build-up to a return to sport. During therapy, the patient will be advised on the correct way of training progression so that a future recurrence of the injury can be prevented.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References
Chen, F.S., Rokito, A.S. & Jobe, F.W. (2001). Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. Vol 9, No 2, March/April 2001.
Magee, D.J., Zachazewski, J.E., Quillen, W.S., Manske, R.C. (2016). Pathology and intervention in musculoskeletal rehabilitation. Elsevier, 2nd edition.