Extending exam to other ligaments

[Lara Anders]

Hi Stephen,

I was wondering if you every extend your study to look at the lateral ulnar collateral ligament? Also when scanning UCL do you assess transverse bundle and posterior as well.

Also how frequently do you see a ligament of Struthers?

[Stephen Bird]

Nice questions Lara,

The LUCL is rarely important in an ultrasound examination. If the radial collateral ligament is intact the LUCL will be fine as it is much stronger. If the RCL has a tear then the LUCL may also be involved. The reason I say it is rarely important on ultrasound is that these patients with RCL and LUCL tears don’t present for ultrasound examination. Clinically they will have posterolateral rotational instability and they will dislocate when tested with a lateral pivot shift test, so they have VERY unstable elbow joints and nobody sends them for an ultrasound.
You can see the LUCL origin at the proximal end of the RCL slightly more posterior to the RCL and you can see the distal insertion onto the supinator crest of the ulna if you stare with a long axis view of the CEO and then turn the transducer exactly 90 degrees you see the LUCL passing around the radial head to the insertion point on the ulna and just superficial to it you almost always see a small array in cross section which is the recurrent interosseous artery.

BUT, we don’t get referred patients as the clinical picture is so obvious they go straight to surgery or perhaps an MRI first.

So I can see it , but it remains a bit of a party trick with little or no clinical utility.

With the UCL I concentrate on the anterior band as this is the major virus stress supporter and where the capsule fails. The posterior band is well seen beneath the ulnar nerve in the cubital tunnel, however it is rarely damaged and the only pathology I see here is OA changes, rheumatoid disease, synovitis, loose bodies etc, rather than post traumatic tearing of this component of the capsule.

The transverse bundle is above my pay grade.

The ligament of Struthers is very rare. Struthers named a lot of useless crap after himself really. The ligament requires a bony spur in the supracondylar region and then the ligament arises from this spur and can cause median nerve compression APPARENTLY.
Personally I have only seen a couple of spurs in 30 + years of scanning and have never seen the Struthers ligament causing median nerve compression so I am concluding it is RARE

Struthers also named the Struthers canal after himself and I do believe in this canal as when I do anatomy day with projections of elbows and upper arms you can see the ulnar nerve disappear into a collagen tunnel about 10 cm above the medial epicondyle and then exit it closer to the shoulder. So I feel it is real. BUT I can’t appreciate it on ultrasound and I have never seen an ulnar nerve being compressed in this area.

So for me Struthers is nought from two !

Steve

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