Much attention is paid to the shoulder when discussing baseball pitching injuries, but the elbow can also be the site of a painful and debilitating ligament sprain or tear.
Ulnar collateral ligament (UCL) injury refers to a sprain, partial tear or complete tear of the ligament that traverses the inside (or medial side) of the elbow. The UCL is the primary stabilizer of the elbow and plays an important role in throwing and hitting sports, such as baseball, football and tennis.
An injury to the UCL has two main causes. First, repetitive stress, as seen in an overhand pitcher, can cause micro-tears in the ligament that, over time, weaken the ligament. This may be due to poor throwing mechanics, fatigue, lack of conditioning or simple overuse. In top pitchers, the elbow accelerates at 600,000 degrees per second. That repetitive stress is why we injure these medial structures, said orthopedic surgeon Dr. Struan Coleman.
Secondly, and less commonly, injury can be brought about by an acute traumatic event, such as an elbow dislocation, which can lead to chronic pain and rupture of the UCL. UCL injury due to acute trauma can be identified by a painful “popping” sensation or range-of-motion loss in the elbow.
In adolescent throwers, rather than tear only the ligament, such an injury may fracture the bone, and as such a break many occur around the bone, it is important to treat a UCL injury early in young athletes.
In “Tommy John” surgery, a physician grafts a tendon from the patient’s hamstring or wrist to replace the torn UCL. Surgeons weave the harvested tendon in a figure eight pattern through bone tunnels drilled in the bones and suture the tendon into place.
Recovery after a UCL surgery will focus on progressive loading emphasizing long-term stress and flexibility. We train for endurance and efficiency. It’s when they get tired is when they’re going to get hurt, said physical therapist Mickey Levinson.
As injury can occur in deceleration after a pitch or throw, rehabilitation also includes practice on using larger body parts to slow motion and reduce stress on the shoulder and elbow.
This post was compiled from a session at the Seventh Annual Current Concepts in Sports Medicine on April 19, presented by Dr. Coleman; Levinson; and Dr. Neal ElAttrache, sports medicine surgeon at the Kerlan-Jobe Orthopaedic Clinic, Calif.; and moderated by Dr. Andrew Pearle, HSS orthopedic surgeon.