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Recurrent Medial Elbow Pain Following Successful Tommy John Surgery

Mark H. Greenberg, MD, RMSK, RhMSUS, A. Lee Day, MD, RMSK, James W. Fant Jr., MD, & Christopher G. Mazoue, MD  |  Issue: August 2020  |  

Ulnar Nerve Relocation: A New Syndrome?

Elements of this proposed syndrome would be: sonographic demonstration of ulnar nerve dislocation pushed by a hypertrophied and dislocating MHTr muscle, with pain occurring at the end of rapid elbow extension.

The typical clinical setting would be in a professional athlete who repetitively throws.

 

References

  1. Barco R, Antuña SA. Medial elbow pain. EFORT Open Rev. 2017Aug 30;2(8):362–371.
  2. Cutts S. Cubital tunnel syndrome. Postgrad Med J. 2007 Jan;83(975):28–31.
  3. Bjerre JJ, Johannsen FE, Rathcke M, Krogsgaard MR. Snapping elbow—A guide to diagnosis and treatment. World J Orthop. 2018 Apr 18;9(4):65–71.
  4. Jacobson JA, Jebson PJ, Jeffers AW, et al. Ulnar nerve dislocation and snapping triceps syndrome: Diagnosis with dynamic sonography—report of three cases. Radiology. 2001 Sep;220(3):601–605.
  5. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986 Oct;68(8):1158–1163.
  6. Somerson JS, Petersen JP, Neradilek MB, et al. Complications and outcomes after medial ulnar collateral ligament reconstruction: A meta-regression and systematic review. JBJS Rev. 2018 May;6(5):e4.
  7. Leland DP, Conte S, Flynn N, et al. Prevalence of medial ulnar collateral ligament surgery in 6135 current professional baseball players: A 2018 update. Orthop J Sports Med. 2019 Sep 25;7(9):2325967119871442.
  8. Gutierrez NM, Granville C, Kaplan L, et al. Elbow MRI findings do not correlate with future placement on the disabled list in asymptomatic professional baseball pitchers. Sports Health. 2017 May/Jun;9(3):222–229.
  9. Garcia GH, Gowd AK, Cabarcas BC, et al. Magnetic resonance imaging findings of the asymptomatic elbow predict injuries and surgery in Major League Baseball pitchers. Orthop J Sports Med. 2019 Jan 20;7(1):2325967118818413.
  10. Cobb F. IV. Report of a case of recurrent dislocation of the ulnar nerve cured by operation: With summary of previously reported cases. Ann Surg. 1903;38(5):652–663.
  11. Lazaro L 3rd. Ulnar nerve instability: Ulnar nerve injury due to elbow flexion. South Med J. 1977 Jan;70(1):36–40.
  12. Xarchas KC, Psillakis I, Koukou O, et al. Ulnar nerve dislocation at the elbow: Review of the literature and report of three cases. Open Orthop J. 2007 Sep 24;1:1–3.
  13. Spinner RJ, Goldner RD. Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. Anatomical and dynamic factors. J Bone Joint Surg Am. 1998 Feb;80(2):239–247.
  14. Rioux-Forker D, Bridgeman J, Brogan DM. Snapping triceps syndrome. J Hand Surg Am. 2018 Jan;43(1):90.e1–90.e5.
  15. Watts AC, McEachan J, Reid J, Rymaszewski L. The snapping elbow: A diagnostic pitfall. J Shoulder Elbow Surg. 2009 Jan–Feb;18(1):e9–e10.
  16. Spinner RJ, Hayden FR Jr., Hipps CT, Goldner RD. Imaging the snapping triceps. AJR Am J Roentgenol. 1996 Dec;167(6):1550–1551.
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