Ulnar Collateral Ligament Injuries of the Elbow Treatment

Ulnar collateral ligament injuries of the elbow occur when the ligament located on the inner side of the elbow is injured. The ulnar collateral ligament (UCL) holds the humerus bone (upper arm bone) and the ulna bone (one of two bones in the forearm) together. It provides stability of the elbow joint during throwing motions. Injuries to this ligament can range from a sprain to a tear and are classified by severity. The grades of ulnar collateral ligament injuries are defined as:

• Grade I: The UCL is strained but not stretched, and is painful.
• Grade II: The UCL has been stretched out but is not torn (is still intact).
• Grade III: The UCL has torn and is no longer able to stabilize the elbow.

Injuries to the ulnar collateral ligament in the elbow often occur due to extreme stress placed on the ligament through repetitive throwing, like pitching a baseball. This injury usually occurs gradually over time with overuse, but may also occur as a result of one throwing injury.

UCL injuries are common in these sports:

• Baseball
• Gymnastics
• Javelin
• Softball
• Tennis

UCL injuries can be prevented by warming up properly, focusing on using correct throwing mechanics, and avoiding overthrowing by limiting the number of throws completed per day or week.

You may be suffering from an ulnar collateral ligament injury if you have pain on the inside of the elbow that inhibits usual throwing techniques. In the beginning, pain is typically present only with throwing. Later on, the pain may progress and become more constant. More specifically, pain associated with an injury to the UCL is worse during the forward motion of throwing, just before releasing the ball.

Occasionally you may feel a pop and have severe pain after throwing one pitch. This is usually associated with a more severe tear. Sometimes, tingling or numbness of the ring and/or pinky finger may be present. This sensation is probably due to ulnar nerve injury.

If you’re experiencing symptoms of an ulnar collateral ligament injury, make an appointment to see an orthopedic specialist. If left untreated, minor injuries can progress to severe tearing and lead to instability of the elbow joint. During your appointment, your doctor will examine your elbow for signs of pain on the inside of the joint when stretching the arm. He/she may also perform a valgus stress test for signs of joint instability. In order to make a diagnosis, your doctor may prescribe the following imaging tests:

• X-rays
• MRI to determine the grade of the tear

If the injury is a grade I or grade II injury (the UCL is not completely torn), you will most likely heal without surgery. Conservative treatments used to treat ulnar collateral ligament injuries include:

• Resting from throwing activities
• Non-steroidal anti-inflammatory medications to reduce pain and swelling
• Icing the affected area throughout the day
• Stretching the arm
• Working to achieve proper throwing mechanics to avoid further injury and prevent injury in the future

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

UCL

If you have a grade III injury or tear of the ulnar collateral ligament, you may want to consider surgery to repair it. This operation is called Tommy John surgery, or ulnar collateral ligament reconstruction surgery. During the procedure, a graft (a piece of tendon from a cadaver or from another area in your body, like your forearm) is used to replace the torn ulnar collateral ligament. Your surgeon will drill small holes in the humerus and the ulna, through which the graft will be threaded and then secured to the bone.

Recovery will depend on the severity of the injury. With non-operative treatment, recovery can range from a few weeks to a few months. Full recovery from Tommy John surgery generally takes one year. Some athletes may need up to two years to return to their previous level of play.

It’s important to follow all instructions given to you by your orthopedic specialist to ensure a proper recovery. You can return to play when you have regained full range of motion and strength without any pain.