The elbow is a hinge joint comprised of the Humerus, Radius and Ulna. Several muscles including but not limited to the Biceps, Triceps and the forearm muscles help control and support the elbow. The major injury of the elbow is injury to the Ulnar Collateral Ligament (UCL). This ligament provides the elbow with stability during overhead activities. This ligament is especially important in throwing, and more so in pitching. Another structure that can cause throwers and other overhead athletes’ problems is the ulnar nerve.
Symptoms of Ulnar Collateral Ligament Injury
Many times the only sign or symptom will be the “pop” that is heard when making a pitch. This pop is the ligament tearing. That pitch may not be the true cause of injury. Many times it is an accumulation of throws were the ligament finally can no longer take the stresses that have been placed upon it.
Diagnosing Ulnar Collateral Ligament Injury
A UCL injury is diagnosed with a thorough medical history, evaluation. Diagnostic tests such as X-ray and or MRI can and usually are utilized as well. X-rays will be taken to look for any fractures or bony abnormalities. The most effective way to evaluate the soft tissues of the elbow is with an MRI. It is important to note that a contrast medium needs to be injected into the joint to ensure that any soft tissues can be seen. In the MRI picture, you see the elbow if you were looking at it from the front with the athlete’s arms straight and palms facing you. The red circle shows where the ligament is ruptured. You will also see some of the contrast medium (in white) in the circle. This is the area where the ligament used to be. The contrast has moved into that are as there is now no tissue there to stop it.
If the athlete desires to resume their overhead activity of choice following UCL injury, the ligament needs to be reconstructed. This is what is known as “Tommy John” Surgery. This surgery was first performed by Dr. Frank Jobe (Dr. Lowe did his Sports Medicine Fellowship under Dr. Jobe). The ligament is reconstructed using the athletes own tissue (autograft). Autograft tissue can be one of the tendons from the forearm known as the Palmaris Longus or even a hamstring tendon. Donor tissue (allograft) can also be used to reconstruct the ligament. Many times during reconstruction, the ulnar nerve will need to be moved in an effort to keep it from being irritated during throwing. The nerve may also need to be moved in those athletes that irritate it, but do not have damage to the UCL. Dr. Lowe will drill tunnels in the bones to pass the new ligament through. He will weave this tissue through the elbow to recreate the UCL. This tissue is then secured in the bone with either screws or sutures depending on the surgical method employed.
Following UCL reconstruction, the athlete will be in a splint with the elbow at 90degrees for about 2 weeks. This is to allow the ligament to begin healing in the tunnels and to allow the incisions to heal. The athlete will then be placed into a hinged elbow brace and will be allowed progressive motion. They will also begin formal therapy. Early, the therapist will move the elbow to keep it from becoming stiff. Eventually, active motion and resistance exercises are begun. Usually, it is around 5 months following “Tommy John” surgery before the athlete begins a graduated throwing program. The rehabilitation protocol for Ulnar Collateral Ligament Reconstruction can be found on this website.