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What is an Ulnar Collateral Ligament (UCL) Tear in the Elbow?

The Ulnar Collateral Ligament (UCL) is a ligament (connects bone to bone) on the medial (inside) aspect of the elbow. The UCL is the main stabilizing ligament that protects the elbow against the stresses from overhead throwing activities. UCL tears occur because of the high stresses on the medial elbow when throwing a ball. While a single event or pitch is able to be identified when the tear occurs, normally an aching elbow exists prior to the formal tear. This type of pain called a prodrome. Increased numbers of daily throws at a young age will predispose the athlete to this injury.

Causes

  • Most commonly occurs in the overhead throwing athlete with increasing activity or overuse of the elbow without proper rest
  • Changes in, or poor throwing mechanics, at the elbow with activity
  • Prior history of pain in the elbow or shoulder with overhead throwing

Signs & Symptoms

  • Pain on the inner aspect of the elbow
  • Occasionally a “pop” will be felt on one specific throw
  • Aching pain after exercise
  • Occasionally sharp pain in the posterior (back) of the elbow when throwing
  • Inability to accurately throw a ball, or loss of velocity while throwing

Treatment

It is important to note that UCL injuries inhibit the ability to participate in throwing activities, but it is unlikely to limit activities of daily living or non throwing activities. Athletes with a UCL tear are usually not limited from batting, running, or exercising in a non-weight-bearing fashion.

Non-operatively, UCL tears can be partial tears and can be treated conservatively in some instances. It is important that athletes recognize and report the aching symptoms that are associated with the prodrome of UCL tears. When recognized, a reduction of athletic activities until completely pain-free is the first step. Athletes then work to achieve normal flexibility and full strength of their arm and shoulder before entering an interval throwing program, and if successful, a progressive return to play.

When a distinct ‘pop’ is felt or continued pain and decreased function while pitching or throwing is present, surgical repair is usually necessary to allow full competitive return to overhead throwing sports. The surgery (Tommy John Surgery) is done as an outpatient typically using a tendon from the leg via an open procedure. Most surgeons perform an arthroscopy first to check for associated problems which might exist and take care of them at the same time. Following surgery, the athlete is braced for several weeks and then will begin a slow progressive rehab process. It is important to follow all guidelines and directions in order to allow for a successful result. Overhead motions and throwing is possible at three months and competition is allowed between six and nine months barring no setbacks.

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