Bony avulsion of the medial ulnar collateral ligament in a gymnast: a case report.

The risk of injury in gymnastics is higher during periods of rapid growth and is directly related to the level of competition. Gymnasts spend an estimated 29% of their season altering their training routine as a result of injury. Most injuries in these athletes are the result of overuse, with upper extremity injuries occurring more frequently in male gymnasts and lower extremity injuries more often in females. Elbow injuries are relatively common in gymnasts due to the repetitive compressive varus and valgus stresses applied. These super-physiologic loads likely contribute to the development of osteochondritis dissecans of the capitellum and medial epicondylitis or apophysitis. Catastrophic injury, such as an acute dislocation, is frequently seen as a result of a missed move, a fall from the apparatus, or an improper dismount. Several case studies have described the extreme of these injuries, such as bilateral elbow dislocations, in a gymnast. In high-level gymnasts, similar to the need of the medial elbow structures in a pitcher in an effort to withstand extreme valgus force, there is a significant valgus load imparted to the elbow with weight bearing and compressive activities such as a back handspring. These forces average 3% of body weight times body height (about 18 Nm). Therefore, the integrity of the ulnar collateral ligament is vital to perform these routines and protect the lateral elbow structures. We describe a case of a young competitive-level gymnast who sustained an injury to both elbows during an uneven bars routine. She had an acute elbow dislocation on her left elbow and an avulsion of the ulnar collateral ligament from the sublime tubercle of the ulna on the right