Attachments and Course The anterior portion, directed obliquely forward, is attached, above, by its apex, to the front part of the medial epicondyle of the humerus; and, below, by its broad base to the medial margin of the coronoid process of the ulna. The ulnar collateral ligament connects the ulnar styloid al process with the triquetrum in a longitudinal orientation deep to the extensor carpi ulnaris tendon and superficial to the ulnomeniscal homologue forming the most ulnar part of the joint capsule 1-2. Always check the cervical spine, as it can be the explanation for pain in the upper limb.Radiographic examination (x-rays, magnetic resonance imaging, and ultrasound) can be used to complement the diagnosis and provide more details.Conservative treatment should be started 6 months prior to any consideration of surgery if the condition is chronic or when the patient is not a young athlete who needs full movement power.Principles of rehabilitation should be used for conservative treatment. The posterior portion, also of triangular form, is attached, above, by its apex, to the lower and back part of the medial epicondyle; below, to the medial margin of the olecranon. Lateral collateral ligament It is composed of 4 parts 1.Lateral ulnar collateral ligament 2.Lateral radial collateral ligament 3.Accessory lateral collateral ligament 4.Annular ligament . Chronic injuries are referred to as gamekeeper's thumb. This was traditionally noticed in Scottish gamekeepers who fractured the necks of the rabbits between their thumbs and index fingers.The thumb MP joint has both static and dynamic stabilizers. On (5B) a fat-suppressed proton density-weighted axial image, the accessory collateral ligament (arrows) is best seen on the ulnar side, coursing from its origin just palmar to the proximal ulnar collateral ligament (asterisk) to its attachment to the plantar plate (P). The ulnar collateral ligament (UCL) originates from the medial humeral epicondyle and inserts on the medial proximal ulna UCL tears result from chronic repetitive trauma (baseball pitching) or an acute fall on an outstretched hand; Most tears are complete; partial tears most commonly occur along the humeral attachment in baseball pitchers When the proper collateral ligament ruptures valgus instability will be present in MP flexion. Either technique requires attachment to the isometric point on the epicondyle, corresponding to the center of curvature of the capitellum. Stress testing of the UCL is performed by placing a valgus stress across the MP joint 30° of flexion and then extension. The proper collateral ligament acts as the primary stabilizer of the MP joint in flexion, and in extension, the accessory collateral ligament and the volar plate are the primary joint stabilizers (,When a valgus stress is applied to the thumb (i.e. Also patients should be instructed regarding the correct posture and ergonomics, to improve function and outcomes.The UCL’s proximal attachment is a broad footprint over the inferior and medial surface of the medial epicondyle. The ulnar collateral ligament of the elbow joint is visible at center left. The static restraints include the volar plate, proper and accessory collateral ligaments. The UCL of the thumb MCP joint has bony attachments deep to the adductor pollicis aponeurosis. As a result, injuries to the ulnar collateral ligament in the professional baseball pitcher are quite common. The most medial aspect of the origin on the anterior band is demarcated by a raphe. Disruption of the ligament, if untreated, can result in chronic joint instability, functional limitation in pinch, and persistent pain 1.Previous clinical and cadaveric studies have suggested that, when a sufficient valgus force is applied to the thumb, … This raphe is the medial margin of the anterior band of the UCL (,The LUCL, or lateral ligament complex, is almost always avulsed from the distal humeral attachment and amenable to repair. Gamekeeper thumb: diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography. The medial (ulnar) collateral ligament (MCL/UCL) complex is a major stabilizer of the elbow joint and resists valgus stress. The ulnar collateral ligament is the primary static stabilizer against valgus stress at the metacarpophalangeal joint of the thumb. Of these, the LUCL is the principal stabilizing component [1, 3, 4]. In,The LUCL is a component of the lateral collateral ligament complex, as previously described, originating from the lateral epicondyle and coursing posterior to the radial head to insert on the lateral aspect of the ulna at the supinator crest.

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