Elbow > Ulnar Collateral Ligament Tears

What is the Ulnar Collateral Ligament?

The ulnar collateral ligament (UCL) is located on the inside of your elbow ­ what is called the medial side ­ on the same side of your elbow as the little finger if your palm is turned upward. The UCL connects the humerus (the bone in the upper arm) with the ulna (one of the forearm bones). Its function is to provide stability to the inside of the elbow during activity.

When your forearm and wrist rotate too far or your elbow bends in the wrong direction, the UCL can be torn, or, depending on the force of the injury, sprained. All ligament injuries are classified into three grades, depending on the severity of the injury. Grade I is an injury to the ligament without any loss in the length relationship, grade II is stretching of the ligament without loss of continuity, and grade III is a loss of continuity in the ligament, commonly called a tear. Grades I and II are almost always treated conservatively without surgery, while grade III injuries need surgery to sew the torn tissue together.


With throwing and particularly pitching, there are strong forces pulling the inside of your elbow in different directions. At the same time, there are compressive forces on the outside of your elbow. These stresses occur with any throwing activity, such as pitching and javelin throwing, and can cause a number of injuries, including tendinitis, injuries to the ulnar nerve (your "funny bone"), and a tear of the ulnar collateral ligament.


If the tear is incomplete, surgery can often be avoided. Then the most important element of treatment is careful attention to throwing mechanics. It has been shown that about 50 percent of velocity is related to the torso and the other 50 percent is related to the arm. Some pitchers incorrectly overload their arms because of improper use of the remainder of the body to propel the arm forward. Surgery to treat severe UCL tears is commonly referred to as Tommy John surgery, named after the major league pitcher who underwent the procedure in the 1970s and became the first player to fully recover from the injury and resume his career. The surgery was performed by Dr. Frank Jobe, a world-renowned expert in Sports Medicine and Orthopedics. The principals of this kind of surgery are time-honored in orthopedic surgery, and had been practiced for many years, even prior to John¹s surgery. The most common tendon used for replacement is the palmaris longus. It is in the front of the wrist, and as far as we know it is a tendon that does not have any specific function, so it serves perfectly as a grafting tissue. Although this is usually an effective operation, it does take time for post-surgical recovery ­ anywhere from six months to two years ­ and the time required to return to pitching activity is longer than that for position players. The main reason it takes time to recover is that the graft itself cannot survive because it has no blood supply. The primary function of the graft is to provide a scaffolding for normal tissue to grow onto, so over time it will be replaced by living, normal tissue which provides the stability of this joint. You cannot speed up that process.


Careful, supervised rehabilitation is essential for a complete recovery. This includes regaining motion in the elbow and rebuilding the muscles in and around the injured area.


Ulnar collateral ligament injuries frequently occur in pitchers because of faulty mechanics. By learning proper throwing mechanics early in a baseball career and developing leg, back, torso, and shoulder strength, many UCL problems can be avoided.


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