In addition, in a feasibility study, Barret et al [12] showed that traumatic ligamentous lesions could be detected on US examination with the identified pathology matching the clinical symptomatology. Of note, no traumatic ruptures of the flexor or extensor tendon origins were detected on this study; however, this was a small study with only 9 patients. Assessment of the anterior bundle of the UCL in athletes is well documented and thus could be useful in the setting of acute trauma as well [20,36-38]. The ability of US to visualize tendinous and ligamentous structures in cadaveric and normal volunteers of the medial and lateral elbow is well accepted; however, there are few articles evaluating its usefulness in the acute setting. A case report by van Duijn and Felton [39] described a case of an 18-year-old collegiate baseball pitcher with preinjury and postinjury US with MR arthrographic correlation. This patient was already participating in a research study evaluating the reliability of UCL thickness measurements using US imaging. In this study, the preinjury US image showed a normal hyperechoic appearance of the anterior band of the UCL. Postinjury images showed disruption of the ligamentous fibers of the anterior band of the UCL, with a large hypoechoic gap separating the 2 torn ends of the UCL, which was confirmed at the time of MR arthrography. A single study by Bilger et al [40] evaluated the use of US in the acute phase of closed elbow injuries and found a strong interrater reliability for injuries of the radial collateral, annular, and anterior bundle of the medial collateral ligaments. They further showed 100% US-surgical correlation in a subset of patients who had surgery. In a cadaveric study, Arrigoni et al [41] evaluated the lateral compartment of the elbow after release of the anterior half of the common extensor origin and after complete radial collateral ligament release. They concluded that US evaluation can detect changes related to tendon tears or
Acute Elbow and Forearm Pain. In addition, in a feasibility study, Barret et al [12] showed that traumatic ligamentous lesions could be detected on US examination with the identified pathology matching the clinical symptomatology. Of note, no traumatic ruptures of the flexor or extensor tendon origins were detected on this study; however, this was a small study with only 9 patients. Assessment of the anterior bundle of the UCL in athletes is well documented and thus could be useful in the setting of acute trauma as well [20,36-38]. The ability of US to visualize tendinous and ligamentous structures in cadaveric and normal volunteers of the medial and lateral elbow is well accepted; however, there are few articles evaluating its usefulness in the acute setting. A case report by van Duijn and Felton [39] described a case of an 18-year-old collegiate baseball pitcher with preinjury and postinjury US with MR arthrographic correlation. This patient was already participating in a research study evaluating the reliability of UCL thickness measurements using US imaging. In this study, the preinjury US image showed a normal hyperechoic appearance of the anterior band of the UCL. Postinjury images showed disruption of the ligamentous fibers of the anterior band of the UCL, with a large hypoechoic gap separating the 2 torn ends of the UCL, which was confirmed at the time of MR arthrography. A single study by Bilger et al [40] evaluated the use of US in the acute phase of closed elbow injuries and found a strong interrater reliability for injuries of the radial collateral, annular, and anterior bundle of the medial collateral ligaments. They further showed 100% US-surgical correlation in a subset of patients who had surgery. In a cadaveric study, Arrigoni et al [41] evaluated the lateral compartment of the elbow after release of the anterior half of the common extensor origin and after complete radial collateral ligament release. They concluded that US evaluation can detect changes related to tendon tears or