Conflicting UCL Tear Diagnosis

Scoping it IS surgery...

But sometimes going in there is the only way to truly determine the injury unfortunately. Even the MRI which is often considered "the Gold Standard" is not perfect.

just sent you a private message (dialog)

I am thinking start over with a new MRI.  It may not be a clear shot.  You need to rule out a tear so you can rehab properly. 

I know doctors who don't like to read the radiologist reports, but rather look at the MRI themselves.  They don't want to be influenced by the report. 

Good luck. 

I've always believed that MRI scans were absolute and definitive, given their high resolution and complexity. Came across an interesting article from a couple years back where even Dr. Andrews casts doubt on their reliability. It's a good read for baseball folk:  http://www.nytimes.com/2011/10...ewanted=all&_r=0

Tim B,

I'm not a doctor, just a parent who has some experience with his son's elbow pain.  IMO, an accurate diagnosis of a torn UCL requires an extremely skilled orthopedic surgeon, and even they don't get it right sometimes.

Was the clinical exam a valgus stress test?  If so, I think a "positive" result would usually include pain, but can also be increased range of valgus movement alone (joint is loose).

Did the MRI include a contrast agent?  That greatly increases the chances of an accurate reading.

I believe the issue with a diagnostic arthroscopy is usually insurance.  If you want to pay for one, that may be on option.

How old is your son?

I would post this question directly on the ASMI forum http://asmiforum.proboards.com/

Thank you for your reply.  He is 15 years old. He had the Valgas Stress test administered by two orthopedics and one trainer. He had no pain and normal range of motion.  The MRI was done without contrast.  We are pursuing a third opinion.  I think it is possible the 2nd opinion was done without viewing the MRI itself, only the paper copies of the images.   

From your description, I think you have reason to be optimistic.  Sounds like the only indication of a torn UCL is from an MRI finding.  I'm sure it doesn't feel this way to you, but time is on your side since he's only 15.

You're in Atlanta, right?  Have you considered a visit to Birmingham?

Here are my thoughts, being the dad of a player who had Tommy John surgery and who has been around quite a few other players who have.  First, you should have an MRA with contrast dye in all cases where a UCL tear is suspected.  I don't know the specifics, but every orthopedic surgeon I've talked to about this has indicated it is better than a standard MRI without dye.  Second, go to someone who is familiar with elbow injuries. Most orthopedic surgeons are not that familiar with a UCL tear or Tommy John surgery.  Third, your son is young, so you have time to treat it conservatively and see how he heals.  If conservative treatment does not heal him and he in fact does have a tear, there is plenty of time for him to have the surgery and recover in time for his varsity baseball a year or more away.

My own son had 2 MRIs.  The first was a standard MRI without contrast as our doctor didn't know any different.  Two separate orthopedic surgeons told us he needed an MRA with contrast, and he then got that.  Neither set of images showed any tear at all, but every surgeon we talked to said it was obviously torn after they examined him.  To make a long story a bit shorter, Dr. Kenneth Akizuki (SF Giants team surgeon and widely regarded as best elbow guy in Northern CA) operated on my son.  It turned out that his UCL was torn in 2 places.  There was an old, partial tear that he'd been playing with, having no pain at all.  The 2nd, newer tear was an avulsion that pulled away from the bone and caused the pain that led to surgery.  The surgery went great but you have to follow your physical therapy instructions to the letter.

Depending on where you live, get a referral to a quality orthopedic surgeon who has experience with elbows.  If you live in California, PM me and I'll be glad to put you in touch with Dr. Akizuki.  He's a great guy, and I'm seeing him on Monday for a problem with my knee that he's been helping me with.