J Korean Orthop Assoc.  2014 Apr;49(2):159-164. 10.4055/jkoa.2014.49.2.159.

Ultrasonographic Serial Evaluation after Reconstruction of the Ulnar Collateral Ligament and the Common Flexor Tendon of the Elbow in a High School Female Weight Lifter

Affiliations
  • 1Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea. chchoi@cu.ac.kr
  • 2Department of Orthopaedic Surgery, Gimcheon Medical Center, Gimcheon, Korea.

Abstract

A 16-year-old female weight-lifter with average records of 70 kg for the snatch event and 90 kg for the clean and jerk event suffered chronic ulnar collateral ligament injury, and underwent ulnar collateral ligament reconstruction. An ultrasonographic evaluation was performed at six weeks, three months, six months, nine months, and one year after the operation. The horizontal and vertical distances measured during the initial ultrasonographic examination as well as at six weeks, three months, six months, nine months, and one year after the operation were 8.4 mm, 2.0 mm, 2.6 mm, 2.8 mm, 2.7 mm, 2.7 mm, and -1.2 mm, 2.4 mm, 1.0 mm, 0.0 mm, 0.0 mm, 0.0 mm, respectively. The lifting records at one year after the operation were 65 kg for the snatch event and 90 kg for the clean and jerk event. The ultrasonographic method of serial examination was useful for evaluation of the rehabilitation program and for deciding on the time to return to competition.

Keyword

weight-lifting athletes; ultrasonography; elbow; ulnar collateral ligament

MeSH Terms

Adolescent
Collateral Ligaments*
Elbow*
Female
Humans
Lifting
Rehabilitation
Tendons*
Ultrasonography

Figure

  • Figure 1 (A) Stress radiograph of the elbow showed widening of the medial joint space of the left elbow joint (right: 4.9 mm, left: 7.0 mm). (B) Magnetic resonance imaging (MRI) examination showing the rupture of the ulnar collateral ligament and common flexor tendon with retraction on the T2-weighted MRI examination and on the coronal and axial images.

  • Figure 2 Three types of angular changes of the medial collateral ligament. Type A: normal stable elbow joint. Type B: increased medial elbow laxity, as manifested by widening of the medial joint space and lateral shift of the proximal part of the ulna. Type C: increased lateral shift of the proximal part of the ulna (arrow) causing impingement of the ulnar collateral ligament on the trochlea (arrowheads). Cited from the article of Sasaki et al.1) (J Bone Joint Surg Am. 2002;84:525-31).

  • Figure 3 (A) Ultrasonographic image of the normal elbow. The medial joint space is shown as a nonechoic space between the subchondral bone of the trochlea (arrowheads) and that of the coronoid process (large arrow). The ulnar collateral ligament (UCL) is identified as a band-like structure that attaches to the medial epicondyle and the tubercular portion of the coronoid process. The superficial surface of the ligament is seen outlined by a hyperechoic straight line (thin arrows). (B) Ultrasonographic findings in ligament injury. The image showing type C angular changes with increased medial elbow laxity, as manifested by widening of the medial joint space (h=8.4 mm) and the lateral shift of the proximal part of the ulna (v=-1.2 mm). UCL tear is shown as a nonechoic gap between the torn margin of the ligament (between × and +). h, horizontal distance of the medial joint space (with the assumption that the outline of the UCL is a horizontal line); v, vertical distance of the medial joint space.

  • Figure 4 Operative findings demonstrating the ruptured and retracted ulnar collateral ligament and common flexor tendon (A), which were reconstructed using the palmaris longus tendon (B).

  • Figure 5 The stress radiograph showed a joint width of 4.3 mm at one year after the operation (A) compared to a joint space width of 3.7 mm of the normal side medial joint space (B).

  • Figure 6 Ultrasonographic finding of both elbow medial joint spaces showing a type A angular deformity at 6 weeks and 3 months after operation (A, B), and type B at 6 months, 9 months, and 1 year after the operation with an intact graft ligament (C, D, E) compared to the type B normal-side elbow (F). Arrows indicated width of the reconstructed ligament.


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