What should you be looking for in this baseball player’s elbow injury?

This 21-year-old has sharp pain (worse with movement) and weakness after a baseball injury. Evaluate contusion. What’s the mechanism of injury?

MRI coronal T2 SPIR

MRI coronal T2 SPIR

Pure valgus insult leads to proximal ulnar collateral ligament tear (arrow) and fracture with hyperintense edema of the radius. Your next move should be to evaluate the rest of the study and exclude an elbow dislocation. In this case, there was none. Your valgus injury checklist should include inspection of:

  1. Proximal aspect anterior bundle of UCL (aUCL)
  2. Sublime tubercle distal insertion of aUCL
  3. Ulnar nerve
  4. Medial epicondyle or apophysis
  5. Aponeurotic layer of flexor digitorum superficialis muscle
  6. Radial head
  7. Capitellum
  8. Olecanon fossa spurring or edema

For more case review, check out MRI Online.

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