Elbow pathology, patient predictors help determine treatment for UCL injury
PHILADELPHIA — Patients with ulnar collateral ligament injuries may experience positive results with nonoperative treatment, according to a presenter here.
According to Russell Huffman, MD, MPH, a physical examination is paramount when diagnosing UCL injuries prior to treatment, and orthopedists should compare the injured and uninjured sides.
“I look at their elbow for range of motion. I look at their shoulder for range of motion. I look at their scapular for symmetry. I look at their core strength. I look at their hip internal rotation, and I do all of that in a thrower with any upper extremity injury or pathology,” he said.
Other elbow pathology, such as osteochondritis dissecans lesions of the capitellum, and issues associated with valgus extension overload should be considered prior to treatment, Huffman noted. He added location of the tear, lower grade and partial tears of the proximal were predictors of successful nonoperative treatment.
“After a multivariate analysis — after assessing for age, handedness, pitching position and other things — the odds of successful nonoperative treatment are dramatically and statistically significantly higher in proximal lesions compared to distal,” Huffman said.
However, patients with a distal avulsion had better results with surgery, he noted.
“If you have a complete avulsion distally, those are not going to do well nonoperatively,” Huffman said. “There is good evidence to treat them with a reconstruct[ion] early. Even if you are going to do that and it is a clear-cut surgical case, you still have to have them get their shoulder motion, have their shoulder strong [and] work on their core strength or it is not going to work.”
Although modalities such as platelet-rich plasma have been shown in previously published studies to have some merit, according to Huffman, it is still unknown whether platelet-rich plasma is beneficial as a nonoperative treatment for UCL injuries.
“I think some modalities like PRP and other things may have merit, but they need to be assessed in the appropriate fashion, which they haven’t yet,” he said. – by Casey Tingle
Huffman R. Diagnosis and non-surgical history of UCL injury. Presented at: Advances in throwing: Latest on injury treatment and performance optimization symposium; Jan. 27, 2018; Philadelphia.
Disclosure: Huffman reports he is a board or committee member of the American Shoulder and Elbow Surgeons; a paid presenter or speaker for LIMA and Linvatex; and receives other financial or material support from Mitek.