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Article Excerpt
ABSTRACT: Elbow instability often results in chronic overuse injuries, especially with overhead throwing in athletes. Initial management of medial collateral ligament (MCL) injuries often is conservative, but surgery may be required. In several studies, nearly half of throwing athletes with MCL injuries who were treated conservatively were able to return to their previous level of competition. Surgical treatment for MCL tears has evolved. Eight to 12 weeks of functional rehabilitation include advanced core-strengthening exercises, progressive neuromuscular exercises, and plyometric upper extremity training. Athletes who present with valgus extension overload should be evaluated thoroughly and considered for MCL reconstruction. Many lateral collateral ligament (LCL) complex injuries do not require surgery. Surgical reconstruction is less well defined with recurrent LCL instability.
Chronic overuse injuries often occur with overhead throwing in athletes as a result of elbow instability. Initial management of a medial collateral ligament (MCL) injury consists of rest, use of antiinflammatory agents, and physical therapy; surgical treatment may be required. Many lateral collateral ligament (LCL) complex injuries that occur with simple dislocations do not require surgical treatment. Management strategies are best devised with an understanding of the elbow's functional anatomy and the relative contributions to instability of the various structures.
This 2-part article describes elbow instability injuries. In the first part ("Evaluating elbow instability injuries," The Journal of Musculoskeletal Medicine, May 2008, page 248), we discussed basic elbow anatomy and biomechanics and evaluation strategies for medial and lateral instability. This second part reviews conservative approaches to treatment and indications for referral for surgery.
MEDIAL INSTABILITY Conservative treatment
In several studies, nearly half of throwing athletes with MCL injuries who were treated conservatively were able to return to their previous level of competition in an average of 24.5 weeks. The nonoperative program that Rettig and associates1...
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