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Experienced Chicago-area orthopedic surgeon Dr. David Burt outlines key facts about UCL tears, including anatomy, injury, symptoms, diagnosis, and treatment options.
The ulnar collateral ligament attaches the medial side of the humerus to the ulna at the elbow and provides stability to the elbow joint. This ligament lives on the medial (pinky finger) side of the elbow and is stressed during athletic activities and with traumatic injuries.
- Injuries of this important ligament have a strong association with vigorous athletic activity, especially sports that involve repeated overhead motion, such as baseball, softball, and javelin throwing.
- A tear of the UCL may happen suddenly, such as when pitching a baseball, or from a traumatic elbow dislocation as may be seen in contact sports, or may happen slowly over time with repetitive stress from overhand sports.
- A UCL injury generates pain on the inner side of the elbow. A sufferer may feel a “pop” at the time of injury in acute cases. Other symptoms include swelling, bruising, or occasionally numbness and tingling into the ring and small fingers.
- Throwers will typically experience loss of speed and control of the ball and feel unable to get into their “slot” with pitching. Volleyball players will have pain, especially with serving, and javelin throwers will have pain and loss of distance and control.
- Dr. Burt will typically evaluate the history of your problems and perform a physical exam, including a valgus test, which measures elbow instability. Evaluation also includes X-rays and an MRI to diagnose the severity of the injury.
- With mild or partial injuries to the UCL, many athletes are able to recover by resting the elbow and following a course of physical therapy to strengthen the muscles that help support the ligament.
- Nonsteroidal anti-inflammatory medications and ice packs can also help treat symptoms in mild cases.
For athletes who continue to have pain and dysfunction of the elbow preventing a return to sport, there are surgical options. Many tears that are partial and/or acute injuries can be treated surgically with ligament repair and augmentation with an internal brace. In more chronic cases it may require ligament reconstruction, commonly referred to as Tommy John surgery.
During this surgery, the ulnar ligament is replaced by a tendon taken from elsewhere in the body or from a donor.
- The new tendon in secured by threading it through holes drilled in the upper arm bone and lower arm bone. It is held in place by screws, buttons or sutures.
- Tommy John surgery is performed as an outpatient procedure under general anesthesia, and lasts about an hour to 90 minutes.
- Recovery from Tommy John surgery involves intensive post-operative rehab, and takes about 12 months to return to full-speed throwing.
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