MANUAL MINORS
Medial collateral ligament (MCL) injury of the elbow occurs when there is excessive stretching or tearing of this ligament, located on the inner side of the elbow. The MCL is crucial for joint stability, especially during throwing motions or valgus (outward) forces. This injury is common in athletes who perform repetitive throwing motions, such as baseball players, and may also result from acute trauma to the elbow.
Diagnosis
The diagnosis is based on clinical history, with symptoms of pain on the inner side of the elbow, especially during throwing motions or when stressing the arm. During the physical exam, a forced valgus stress test is performed, which reproduces pain in the ligament area. The injury can be confirmed with ultrasound or magnetic resonance imaging (MRI), which allow assessment of the ligament damage (stretching or complete tear).
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Medial epicondylitis | Chronic pain on the inner side of the elbow, related to wrist flexion |
Ulnar nerve injury | Pain and tingling in the hand, associated with nerve compression |
Medial condyle fracture | Acute pain after trauma, visible on X-rays |
Elbow arthritis | Chronic pain and swelling, not directly related to throwing motion |
Triceps tendinopathy | Pain in the back of the elbow, associated with overuse of the muscle |
Emergency Management
In the emergency setting, initial management of an MCL injury includes immobilising the elbow, applying ice to reduce inflammation, and using analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) for pain control. If a complete tear is suspected, the patient should be referred for specialised orthopaedic evaluation. Partial injuries are usually managed conservatively with rest, although a temporary splint may be necessary in more painful cases.
Definitive Treatment
Definitive treatment depends on the severity of the injury. Mild or partial injuries are managed with physiotherapy to strengthen the muscles around the elbow, along with activity modifications to avoid repetitive stress. In athletes with complete tears or persistent instability, ligament reconstruction surgery (such as “Tommy John surgery”) may be required. An intensive rehabilitation programme follows to restore elbow function and mobility, aiming for a return to sports activities.
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