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What is an Elbow Ulnar Collateral Ligament Tear?

The ulnar collateral ligament is a band of tissue connecting the humerus to the ulna, supporting and stabilizing the arm during motion. An ulnar collateral ligament tear is generally a repetitive stress injury to the interior of the elbow, compromising its stability.

It’s a common injury among athletes who engage in “overhead” sports, such as baseball or volleyball. Ulnar Collateral Ligament Tears are often referred to as “Tommy John” injuries, named for the famed baseball pitcher who underwent the first surgery of its kind in 1974.

Characteristics and Clinical Presentation of an Ulnar Collateral Ligament Tears

At the time of injury, an athlete may experience pain and tightness in the region surrounding the humerus and ulna (the inside of the elbow). As time goes on, and with repeated stress to the area following this trauma, this ligament can begin to stretch and eventually tear. The injury can be a result of acute or chronic trauma, so it is not necessary to hear a “pop” at the time of injury.

Symptoms of an ulnar collateral ligament tear include:

  • Soreness
  • Tightness, weakness, diminished velocity and endurance
  • Swelling and bruising
  • Numbness and tingling
  • Instability in the elbow joint

Getting a Diagnosis for an Ulnar Collateral Ligament Tear

A specialized health practitioner, like Dr. Mark or Jason Pruzansky, will conduct a thorough physical examination. This will include your overall health and history of activity. It’s important to know when and how the injury occurred (acute or chronic), how long you have had the pain, if you are experiencing any pain or loss of sensation, if there was a pop in the elbow while performing an overhead throw, and if you have experienced instability and weakness in the elbow or forearm.

For a more definitive diagnosis, magnetic resonance imaging (MRI) may be used to evaluate possible damage to the ligamentous tissue. Arthroscopy is very helpful in this regard.

Treatment Options for an Ulnar Collateral Ligament Tear

In many cases, a traumatic ulnar ligament tear will heal on its own. When the injury is identified, an initial period of rest and immobilization can promote healing. This allows the ligamentous tissue that was damaged or stressed to repair itself to the degree possible without surgical techniques. After receiving clearance from a hand surgeon, patients can rest their elbow by applying P.R.I.C.E principles:

  • Protect: the injured area might be protected briefly with a splint or sling.
  • Rest: the injured elbow should be allowed to rest.
  • Ice: use a cool pack or ice bag to reduce swelling and pain.
  • Compression: prudently wrapping the area with a bandage may limit the amount of swelling that can occur.
  • Elevate: elevating the elbow also helps control swelling by using gravity to limit and reduce the amount of fluid that goes to the affected area.

Conservative Treatments

In cases where the injury should respond to conservative methods, your hand surgeon may temporarily immobilize the elbow with a sling or splint. A period of rest, with nonsteroidal anti-inflammatory medications, and rehab are often enough to stabilize the elbow following this injury.

After the inflammation has decreased, patients are advised to begin physical therapy to strengthen the muscles surrounding the elbow to further restore mobility and range of motion. The kinetic chain will be evaluated to assess and remediate all areas from the ground up contributing to excessive elbow strain.

Surgical Treatments

If the injury does not respond to conservative treatments, or if the ligament requires immediate surgical intervention, your surgeon may recommend an Ulnar Collateral Ligament reconstruction (Tommy John Surgery).

This procedure requires a tendon graft from a donor site from another part of the body, often the forearm, which will serve as the new ulnar collateral ligament. Tunnels are drilled in the humerus and ulna to secure the tendon draft. Any remaining tissue of the original ligament may then be attached to this graft to provide strength and mobility.

Preventing an Ulnar Collateral Ligament Tear

Throwing athletes should cease athletic activity immediately if the interior of the elbow begins to hurt, especially during overhead throws. A revised stretching and strength training routine involving core strength is likely to reduce injuries. Injuries to the elbow can be reduced by slowly warming up for athletic performance and resting sufficiently between practices and games.

If you notice pain in the interior of the elbow following throwing activities, you should rest the area immediately and seek medical supervision.

Prognosis for an Ulnar Collateral Ligament Tear

In cases where the injury may be treated without surgery, the recovery may take several weeks or months. The healing period depends on the degree of injury and the level of performance you’re attempting to restore. During this time, you will work with your surgeon and a physical therapist to work towards your goal.

If Tommy John surgery is required, rehabilitation can take 9 months to 1 year, or longer, to recover. The elbow may be placed in a hinged brace to gradually increase range of motion until full flexion and extension are allowed. It offers some degree of protection as well. Physical therapy will be required during this time to strengthen the elbow, especially if you wish to return to athletic activities.

If You Believe You Have an Ulnar Collateral Ligament Tear, Contact HandSport Surgery Institute.

Please contact us as soon as possible to schedule an appointment with our talented team. People who have been hurt should be evaluated to try to prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.

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