Felix H. Savoie III, MD

ABSTRACT: Elbow instability often results in chronic overuse injuries,especially with overhead throwing in athletes. Initial managementof medial collateral ligament (MCL) injuries often is conservative,but surgery may be required. In several studies, nearly half ofthrowing athletes with MCL injuries who were treated conservativelywere able to return to their previous level of competition. Surgicaltreatment for MCL tears has evolved. Eight to 12 weeks of functionalrehabilitation include advanced core-strengthening exercises, progressiveneuromuscular exercises, and plyometric upper extremitytraining. Athletes who present with valgus extension overloadshould be evaluated thoroughly and considered for MCL reconstruction.Many lateral collateral ligament (LCL) complex injuries do notrequire surgery. Surgical reconstruction is less well defined withrecurrent LCL instability. (J Musculoskel Med. 2008;25:342-344)

ABSTRACT: Instability may result in overuse injuries in the medialor lateral aspect of the elbow with overhead throwing in athletes.Understanding the functional anatomy helps physicians in the diagnosisand management of injuries. The ulnohumeral articulationprovides a significant amount of inherent stability. An abductionstress test may be used to evaluate medial collateral ligament (MCL)integrity. Patients who have lateral instability usually present withsymptoms after an elbow dislocation. The most sensitive test may bea lateral pivot shift apprehension test. Initial management of an MCLinjury consists of rest, use of anti-inflammatory agents, and physicaltherapy; surgical treatment may be required. Many lateral collateralligament complex injuries that occur with simple dislocations do notrequire surgical treatment. (J Musculoskel Med. 2008;25:248-252)