Ulnar Collateral Ligament Injury in the Throwing Athlete

By Dr. Michael Cushing

Spring is here and baseball season is in full swing. The volume of elbow injuries seen in our office are also in full swing. There are many causes of elbow pain in the throwing athlete. These include Little Leaguer’s Elbow, Tendonitis, Osteochondritis Dessicans and Ulnar Collateral Ligament injuries. The question on parents minds is “Does my child need Tommy John surgery?”

What is the ulnar collateral ligament(UCL) in the elbow? The UCL is the primary elbow stabilizer. It is located on the inside (medial) aspect of the elbow.

What causes this injury to occur? The ligament is stretched, frayed or torn from the repetitive stress of throwing. Commonly, over months (sometimes years) of throwing, microtears occur and eventually lead to rupture. Occasionally, a single throw will cause the injury. The frequency of this injury in children between 10-18 has increased. Longer seasons with extended practice times and more tournaments increase the risk of UCL injury. Throwing volume, pitch type and throwing mechanics can contribute as well.

How does my doctor diagnose a UCL injury? Diagnosis is based on a patients history and symptoms. Your physician will perform a thorough physical examination of the shoulder and elbow, including special test specific to the UCL. The most common complaint is pain along the inside of the elbow, especially during the acceleration phase of throwing. The pain is often chronic or recurrent. Patients will report having elbow pain last season. Radiographic test including xrays and an MRI with contrast will help in the diagnosis.

If I have a UCL injury, does that mean I need surgery? Many UCL injuries are treated successfully with rehabilitation and rest. Typically, this involves at least 3 months of rest. When the pain and swelling resolves, a throwing program can be initiated. However, when conservative measures fail, surgery is indicated. The ligament is not repaired, it is reconstructed with a tendon from another part of your body (usually forearm).

What is the recovery and what are the results of UCL reconstruction? Recovery from surgery involves extensive physical therapy. Initially, a brace is used to protect the reconstruction. After 4-6 months, a throwing program can be initiated with return to competitive throwing between 9-12 months. Rehab is usually 1 year for pitchers and 6 months for position players. Full recovery and a return to a similar level of play is between 85-92%.

How do you prevent these injuries from occurring? Injuries to the UCL are best prevented by proper throwing mechanics. Coaches are essential to assessing the proper throwing techniques in athletes. Thorough warm-up and flexibility exercises play an important role in prevention as well.

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