The elbow is a complex structure containing bones, muscles, tendons, and ligaments that provide stability to the elbow. As such, elbow injuries often involve more than one structure.
The collateral ligaments in the elbow provide enhanced stability. The ulnar collateral ligament (UCL) is also called the medial collateral ligament. The UCL is a complex on the inside of the elbow that stabilizes the elbow during various motions such as throwing. Through trauma and overuse, these stabilizers may become compromised.
Who is at risk for a UCL injury?
UCL injuries are the most common cause of time lost in collegiate pitchers. Elbow injuries to college baseball pitchers account for 7-8% of injuries. UCL injuries are common in pitchers, gymnasts, javelin thrower, wrestlers, quarterbacks and offensive linemen. Athletes who play ice hockey, water polo, tennis, other racquet sports and volleyball are also at risk.
What are the symptoms?
Symptoms of a rupture include:
- Medial elbow pain
- a sensation of popping in the elbow and immediate pain along the inside of the elbow
- swelling and bruising
- elbow instability
- reduced range of motion
- sudden decrease in throwing velocity
- impaired performance
- loss of stamina and strength
What causes a UCL injury?
Injury to the UCL typically occurs because of a chronic accumulation of microtrauma related to stresses caused by specific repetitive motions that deteriorate the ligament over time. However, an acute UCL rupture can result from a traumatic accident during a wrestling match or a football tackle. In addition to repetitive motions, poor mechanics that stress the elbow cause small chronic microtears that deteriorate the ligament until it eventually breaks or ruptures.
How is a UCL tear diagnosed?
During your consultation with Dr. Cooper, he will ask about your medical history, your symptoms and the circumstances surrounding the injury. He will conduct a thorough physical exam to evaluate not only the elbow but also the shoulder’s range of motion. A variety of specialized tests for UCL are available to identify tears including a valgus stress test. Many athletes complain that medial elbow pain occurs when they cock the elbow in the first stage of throwing. To confirm a clinical diagnosis, Dr. Cooper will order advanced imaging such as MRI and/or ultrasound where the UCL is clearly visualized.
What are the treatment options?
Nonsurgical treatment involves rest, icing, anti-inflammatory medications, platelet-rich plasma (PRP) injections, splints or brace at night and physical therapy, followed by strengthening exercises and a brace. The focus is on alleviating pain and swelling while strengthening and stabilizing the elbow.
Patients who fail nonoperative treatment and have significant dysfunction and pain with a desire to return to play are good candidates for surgery. When there is a complete UCL rupture, early surgery may be recommended. however, the patient must be prepared for an extensive, rigorous post-operative rehab. Surgery is not for performance enhancement.
In some cases, the ligament may be repaired, while in others the ligament must be reconstructed. The reconstructive surgery is ulnar collateral ligament reconstruction or (UCLR), commonly known as “Tommy John” surgery. A tendon is taken from another part of the patient’s body and used to rebuild the torn UCL. If an autograft is not possible, a donor allograft will be used. Studies report that MLB pitchers who underwent Tommy John surgery returned to pitching 83% of the time.
A variety of other surgical techniques are available for reconstruction in symptomatic throwing athletes. Return to play preparation can begin at 6-9 months after surgery, but to be game ready can take anywhere from 10-18 months.
UCLR in the non-throwing athlete with a UCL tear also demonstrates good outcomes and high return to play with focused rehab.