Ulnar Collateral Ligament Injury

Ulnar collateral ligament injuries typically result from either acute trauma or chronic repetitive stress.

• Acute ulnar collateral ligament injuries are less common and often occur due to a sudden application of force that overstresses the ligament, such as a fall onto an outstretched arm or a sudden impact during sports.
• More commonly, ulnar collateral ligament injuries are due to chronic overuse, especially in athletes who frequently engage in overhead throwing motions. The repetitive stress on the elbow joint causes microtears in the ligament, leading to gradual degeneration and eventual rupture. This can occur in children and adolescents as well as adults who participate in throwing sports such as baseball and soft ball and is common in pitchers.

The symptoms of an ulnar collateral ligament injury can vary depending on the severity of the injury but generally include:

1. The most common symptom is pain on the inner side of the elbow. It is typically aggravated by throwing or other activities that put stress on the elbow.
2. The injured area may become swollen or bruised shortly after the injury.
3. Some individuals report feeling a “pop” at the time of injury, particularly during a high-force throw.
4. The elbow may feel weak or unstable, especially when attempting to throw or perform similar motions.
5. Pain and swelling can lead to a reduced range of motion in the elbow joint.

Dr. Zahab Ahsan will inquire about your symptoms and how the injury occurred. He will conduct a physical examination to assess range of motion, check for tenderness along the ulnar collateral ligament, and perform specific stress tests to evaluate the stability of the elbow. Imaging studies, such as X-rays, will be ordered and are used to rule out fractures or other bone abnormalities. Magnetic resonance imaging is the most definitive tool for diagnosing ulnar collateral ligament injuries as it provides detailed images of the soft tissues, including the ligaments.

The treatment of Ulnar collateral ligament injuries depends on the severity of the injury and the patient’s level of activity.

1. Non-Surgical Treatment: For partial tears or less severe injuries, conservative management is usually recommended. This may include rest, ice application, anti-inflammatory medications, and physical therapy focused on strengthening the muscles around the elbow and improving flexibility. A period of rest from throwing or other activities that exacerbate the injury is often necessary.
2. Surgical Treatment: Surgical intervention, commonly known as “Tommy John surgery,” is often considered for athletes or individuals with complete tears or chronic instability that do not respond to conservative management. The procedure involves reconstructing the ulnar collateral ligament using a tendon graft, typically harvested from the patient’s forearm (palmaris) or hamstring. This surgery is safe and effective with a majority of patients returning to their prior level of activity and performance with a gradual rehabilitation program.

Tommy John surgery changed baseball. More than 1,000 professional pitchers have had the ulnar collateral ligament in their pitching elbow reconstructed since Frank Jobe, MD, operated on Tommy John in 1974. The share of active major-league pitchers who had undergone Tommy John surgery hit 35.3% in 2023, a 29% rise since 2016.

This surgery is well-known in the big leagues, but it is becoming more common in young athletes ages 15-19 with elbow injuries. Overuse is the main reason athletes need this surgery.

There is additionally a newer surgery known as UCL repair with internal brace that has garnered additional attention as an opportunity to make a quicker recovery and return to sports in 6-8 months. This is applicable to specific types of UCL injuries.

Recovery from an ulnar collateral ligament injury can vary depending on the treatment approach and the individual’s compliance with rehabilitation protocols. Non-surgical management typically involves a few months of rest and rehabilitation.

Rehabilitation plays a crucial role in both non-surgical and post-surgical recovery, focusing on restoring normal elbow mechanics, improving muscle strength, and preventing future injuries. Rehabilitation following surgery is extensive and can take 9 to 12 months, during which time the patient gradually progresses through a structured program aimed at restoring strength, range of motion, and functional capacity.

Ulnar collateral ligament injuries are a significant concern, especially for athletes involved in overhead sports. Early diagnosis and appropriate management, whether conservative or surgical, are essential to optimize outcomes and facilitate a return to sport or daily activities.