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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

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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