0:00

We're gonna turn our attention now

0:02

to the lateral collateral ligament as complex.

0:05

And here you can see the three ligaments with which we deal.

0:10

The first one that was emphasized in the literature years

0:13

ago was the radial collateral ligament.

0:16

It runs from the lateral epicondyle to the a**l ligament.

0:21

Later on discovered was the lateral ulnar collateral

0:24

ligament running also from the lateral epicondyle

0:28

behind the radio head attaching to the ulnar in the region

0:32

of the supinator crest.

0:34

The a**l ligament is, uh, surrounds the radio head

0:39

and neck patching to the on, on either side.

0:43

And then there is, although not shown here,

0:46

an accessory on your ligament, which is not considered

0:49

as important and I will not be discussing it.

0:52

Now, as you look at that diagram on the left,

0:55

let me point out that for many, many years,

0:59

orthopedic surgeons

1:00

and clinicians felt that the

1:03

radial ligaments were not important

1:05

for stability of the elbow.

1:07

And that was based on the fact

1:09

that the radial collateral ligament,

1:11

which is the one they knew, ran from bone to ligament

1:15

and not from bone to bone.

1:18

With the discovery of the lateral ulnar collateral ligament,

1:21

which does run from bone to bone, the importance

1:25

of the lateral collateral

1:27

ligamentous complex became more obvious.

1:31

To give you an idea of what these ligaments, uh, look like

1:35

here in anatomic sections in the coronal plane,

1:39

the more anterior section at the top,

1:41

this is the radio collateral ligament.

1:44

It runs down almost vertically.

1:47

It attaches to the a**l ligament,

1:49

and you can see that the lateral ulnar collateral ligament

1:53

and the radial collateral ligament are intimate proximally.

1:57

So the easiest way to tell them apart is to start distally

2:01

and then move up proximally, which is what I do.

2:04

The bottom image shows you

2:07

that lateral ulnar collateral ligament.

2:10

Now, many times you don't see it in a single MR image.

2:13

Here we're seeing most of it in a single coronal section.

2:17

When I study Mr to find this particular ligament,

2:21

I find it first down here,

2:23

and then I follow it up approximately to its attachment on

2:27

that lateral epic peronial.

2:31

Here is what that lateral NAR collateral ligament would look

2:35

like in a cric section at the top,

2:38

and here you can see it very, very nicely as it swings down

2:43

behind the radial neck to attach

2:46

to the supinator crest of the ulnar.

2:50

The third ligament on the lateral side that I would like

2:53

to emphasize is the annular ligament.

2:57

I draw, I made a

2:58

Quick drawing of it,

2:59

and mainly to emphasize this is not a thin

3:02

strip of ligament.

3:04

This is a broad band of ligament that covers the neck,

3:08

covers the head,

3:09

and may actually extend above the radial head into the joint

3:14

where it can simulate something.

3:16

I'll talk about in a little in a few minutes an abnormal

3:20

synovial fringe.

3:21

If you look at the top image, you can see that

3:24

that anular ligament is above the radial head,

3:27

which it may be.

3:30

Here are some pictures from a study we did at the,

3:33

looking at the anatomy in detail of the anular ligament

3:38

and typically the anterior attachment here.

3:43

Okay, in this region is usually a single band,

3:47

but as you follow it around to its posterior attachment,

3:50

it may be a single band

3:53

or a triangular area with two bands.

3:57

You don't wanna mistake that for a sign of pathology.

4:01

This area of the ulna is called the radial notch,

4:05

and it's that that is intimate with the radial head

4:09

and neck.