A radial collateral ligament tear elbow is a relatively uncommon but significant injury, particularly in individuals involved in racquet sports and weightlifting. The radial collateral ligament is crucial in stabilising the outer elbow. When torn, the ligament compromises elbow stability, leading to pain and weakness. So, how do you know you had a radial collateral ligament sprain elbow, and what can you do about it?
What is the radial collateral ligament?
The radial collateral ligament comprises four strong ligaments surrounding the outside of the elbow. Generally, more than one of these ligaments must be torn before instability occurs. The large extensor tendon of the elbow (causing tennis elbow) sits above these ligaments.
Causes
A radial collateral ligament sprain or tear can occur due to an acute injury, repetitive stress, or previous elbow injuries.
One of the most common causes of a ligament tear is a fall onto an outstretched hand, which can place excessive force on the outer elbow and overstretch the ligament. Elbow dislocations are one example of severe acute injury. Also, repetitive stress from sports such as tennis, baseball, and weightlifting can develop ligament injuries due to excessive forces on the outer elbow. Another common presentation is repeated cortisone injections for tennis elbow. As the ligament sits under the tennis elbow tendon, inaccurate cortisone injections can weaken this ligament, causing tearing.
Symptoms of a Radial Collateral Ligament Tear Elbow
Patients with a radial collateral ligament tear elbow typically experience the following symptoms:
- Outer elbow pain that worsens with activity, gripping, or lifting objects.
- Instability or giving way with specific movements, such as pushing off.
- Clicking or popping with elbow movements
- Recent history of tennis elbow +/- cortisone injections
Diagnosis
Your sports doctor will perform an assessment. Often, there is tenderness over the outside of the elbow, close to the tennis elbow tendon. Sometimes, individuals also have tennis elbow, so it may be challenging to differentiate between the two conditions. We commonly use a stress test, where your doctor applies inward pressure on the elbow, revealing increased movement. Another helpful test is the chair push-up test, in which individuals may feel pain or instability when pushing themselves up from a chair using their arms. Performing a push-up with the forearm rotated outwards can also cause pain or clunking.
Imaging studies are often required to confirm the diagnosis. MRI is the gold standard for diagnosing ligament tears, providing a detailed vision of ligament integrity and any associated soft tissue injuries. Sometimes, we see cartilage damage in the elbow joint. Ultrasound can also help look at the ligament structure.
Treatment of a Radial Collateral Ligament Sprain or Tear
The treatment of an RCL tear depends on the severity of the injury.
For radial collateral ligament sprains, simple conservative treatment is often effective. Rest from aggravating sports is essential. Sometimes, wearing a hinged elbow brace IImmobilisationwith a hinged elbow brace may be used for 2-4 weeks to stabilise the elbow and allow healing. Physiotherapy plays a crucial role in recovery, strengthening the surrounding muscles to compensate for ligament insufficiency. Strengthening exercises target the forearm and wrist muscles to enhance overall elbow stability.
In some cases, platelet-rich plasma (PRP) therapy can enhance ligament healing.
We recommend surgery for complete ligament tears or chronic instability. Ligament repair is an option if the ligament is torn but still in good condition, allowing it to be reattached to its original site. In cases where the ligament is severely damaged, a graft is used to restore stability. Generally, the surgery results are promising, with 75% success, although a minority will experience ongoing instability.
Other Frequently Asked Questions on Radial Collateral Ligament Tear Elbow
Is there a link between persistent tennis elbow and radial collateral ligament tear?
Yes. Tennis elbow (or lateral epicondylitis) can cause persistent outer elbow pain. In chronic cases, the radial collateral ligament complex may also be torn, leading to ongoing pain and instability. Repeated cortisone injections can also increase the risk of ligament damage.
What are the other causes of clicking or popping in the elbow?
Other causes of elbow pain and clicking include damaged elbow joint cartilage, loose bodies in the joint, triceps snapping syndrome, ulnar nerve dislocation, OCD of the elbow and elbow plica syndrome. See your doctor if you have persistent elbow pain with clicking or popping.
Final Word from Sportdoctorlondon about Radial Collateral Ligament Tear Elbow
A radial collateral ligament tear elbow is a significant yet often overlooked injury, particularly in individuals engaging in repetitive upper limb activities or cases of persistent tennis elbow. Early recognition and appropriate management are crucial for preventing long-term complications. While many partial tears respond well to conservative treatment, severe cases may require surgical intervention.
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