Lateral Collateral Ligament (LCL), LUCL & RCL tears
The Lateral Collateral Ligament (LCL) is a ligament complex on the lateral (outside) part of the elbow comprised the Lateral Ulnar Collateral Ligament (LUCL) and the Radial Collateral Ligament (RCL), and is very important for elbow stability. It is not to be confused with the Ulnar Collateral Ligament (UCL) which has a very similar name but is on the opposite side of the elbow. The LCL/LUCL is less commonly injured, but is just as important as the UCL to maintain stability of the elbow. It typically is injured from a trauma to the elbow such as an elbow dislocation and is often associated with fractures about the elbow.
Pain on the outside part of the elbow and even gross instability can be felt with range of motion of the elbow and especially with weight bearing on the elbow such as when trying to do a pushup or getting up from a chair by pushing up on the armrests with your arms. Those with the most severe versions can feel their elbow being unstable and at times can actually feel their elbow feel out of place or partially dislocated. Over time, untreated LCL/LUCL tears can lead to bone spurs and osteoarthritis.
On physical examination, there is typically localized tenderness in the distribution of the LCL/LUCL which goes from the Lateral Epicondyle (bony prominence on the outside part of the elbow) to the Supinator Crest of the Ulna. Dr. Steven Lee will also perform some provocative tests to help elicit pain or instability of the elbow to help diagnose the disorder. One of those tests is called the "Chair Lift Off Test" where he might ask you to lift yourself from the chair by just using your arms.
This diagnosis can easily be mistaken for Lateral Epicondylitis as well since it is in the same area, and sometimes patients with LCL/LUCL disorders also have Lateral Epicondylitis as well.
X-rays are normally ordered to rule out a fracture, especially since LCL/LUCL injuries are often associated with fractures about the elbow. An MRI is often ordered to determine the presence or severity of the tear, as well as to rule out other diagnoses.
LCL/LUCL tears that are partial can be treated with non-operative treatment first, often with a hinged brace for at least 6 weeks, followed by physical therapy for at least 6 weeks. The option of adding biologic stem cell therapy such as Platelet Rich Plasma (PRP) may be discussed to help accelerate and improve upon the healing response.
Surgery is recommended on a case by case basis, but is usually indicated for complete tears of the LCL/LUCL especially in those patients who feel instability of the elbow, or have partial tears or pain that have failed nonoperative treatment. It is almost always also recommended for patients who also associated fractures of the elbow.
Elbow surgery is an area requiring special expertise in order to master because some elbow surgery is typically performed by hand surgeons, and others by sports surgeons, yet neither of them typically do a large quantity of elbow surgery. Dr. Steven Lee is uniquely fellowship trained in both hand/upper extremity surgery as well as sports medicine, and has is one of the most experienced orthopaedic surgeons for elbow surgery in NYC. This particular operation happens to also be one that Dr Lee has a special interest in and has been pioneering innovative newer and stronger techniques compared to what is currently being done. Dr. Lee invented and wrote up the technique that is now widely being used by most orthopaedic surgeons around the country. He also regularly instructs courses teaching other orthopaedic surgeons how to perform this operation. If you are interested, please click here to watch Dr. Steven Lee demonstrate this surgery (Warning: graphic content).
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All surgical patients are immediately immobilized in a non-removable splint from above the level of the elbow to the hand for 7-10 days following surgery. During this time, patients are encouraged to elevate their hand above their heart, keep their dressings clean and dry, and to move their fingers. Patients are allowed to use their fingers to text and type, but not to lift anything heavier than a cup of coffee or that which causes them more than a 2/10 pain level.
Patients will then be transitioned into a locked elbow brace and wrist immobilizer for 3 weeks. After this, the patient will be required to start occupational therapy (OT) to regain back strength and mobility. While many patients will be surprisingly functional 6 weeks out from surgery, it often takes up to 4-6 months to be cleared for all activities including sports.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.