MEDIAL ELBOW ANATOMY: A PARADIGM SHIFT FOR UCL INJURY PREVENTION AND MANAGEMENT

Review written by Dr Carlo Wood info

BACKGROUND & OBJECTIVE

There is an increasing incidence of ulnar collateral ligament (UCL) injury in overhead throwing athletes. Treatments range from either nonoperative management or reconstruction which is proven to be an effective option. However, unnecessary surgeries and long recovery periods are a concern. Improvement in nonoperative management and diagnostic accuracy are necessary.

Controversy exists whether the anterior bundle of the UCL is the primary static stabilizer against valgus during throwing, with the flexor-pronator mass (FPM) assuming dynamic stabilization. This study’s aim was to analyze the medial side of the elbow joint in terms of the tendinous structures and capsule rather than the specific ligaments.

METHODS

Cadavers were used for gross and histological examination of the medial elbow in order to measure the dimensions of the capsular attachment and footprints of tendons of the FPM. Joints were sectioned in the axial plane at the level of the sublime tubercle (ST) just distal to the joint and in the oblique coronal plane at the level of the anterior slope of the medial epicondyle (MEC) then stained. Bone morphology was analyzed with a µCT (micro-computed tomography) scanner. Radiopaque markers were used along the tendinous septa (TS) to identify the relationship between the ST and the tendons.

RESULTS

A superior TS between the pronator teres (PT) and flexor digitorum superficialis (FDS) is penetrated by the median nerve. It originates from the anterior slope of the MEC (as a continuation from the intermuscular tendon of the brachialis) and extends

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