What is an ulnar collateral ligament tear?
The ulnar collateral ligament (UCL) is the main stabilizing ligament on the inside of the elbow. The UCL helps athletes, especially throwing athletes, with the ability to throw or put force on the inside of the elbow. This injury is commonly thought of as a baseball throwing injury, but other sports can also cause too much stress on the inside of the elbow and a tear, like softball, tennis, water polo, volleyball and any throwing type sport.
Mechanism of Injury:
Commonly, the UCL tear is thought of as a tear that occurs as a result of a baseball or throwing injury. The surgery (Tommy John surgery) for this tear got its name for the surgery that was performed on a Hall of Fame pitcher that played for the Yankees and Dodgers. This type of strain or tear is usually caused by excessive stress on the ligament usually due to over throwing, repetitive motions, or an acute injury. Although pitchers in baseball are recognized as the main athletes affected by this injury, an UCL tear/sprain can occur in any throwing athlete but also occur as a result of a traumatic injury.
Symptoms and Diagnosis:
The most common complaint of an UCL tear is pain on the inside (or medial) aspect of the elbow. This often occurs in pitchers due to poor pitching mechanics and excessive stress to the inside part of the elbow. The physical exam will demonstrate pain and laxity of the inside part of the elbow with certain maneuvers. X-rays of the elbow should be performed to rule out bone injuries or chronic changes to the elbow joint that can result in pain. Advanced imaging (usually a MRI with fluid injected into the elbow) is often performed to determine the full extent of the injury.
Treatment of UCL tear:
Initial treatments will focus on non-operative management of UCL tears and sprains. This will include ice, anti-inflammatories, stopping a sport for a period of time, and physical therapy to help strengthen the muscles around the elbow. If rest and physical therapy do not solve the issue, then advanced imaging is often performed. Surgery is reserved for people that do not progress with non-operative treatment or continue to have pain despite rest and rehabilitation. Surgery is commonly a reconstruction of the ligament using one’s own tendon or someone else’s tendon, also known as Tommy John Surgery. A repair of the UCL tear can also be performed and is often attempted in pediatric throwing athletes. The recovery is often lengthy and requires extensive physical therapy.
For more information, please consider the following link that was produced by the AAOS.
https://orthoinfo.aaos.org/en/diseases–conditions/elbow-injuries-in-the-throwing-athlete
https://orthoinfo.aaos.org/en/diseases–conditions/throwing-injuries-in-the-elbow-in-children