> Ulnar Collateral Ligament
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
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.