Ulnar Collateral Ligament (UCL) Tears were once devastating injuries to an athlete involved in overhead and throwing sports such as swimmers, volleyball players, pitchers and ice hockey players. But today early diagnosis and treatment keeps players in the game without skipping a beat.

The UCL of the elbow is critical for valgus stability and serves as the primary elbow stabilizer. It consists of three bands – the anterior, posterior and transverse. The anterior band contributes the greatest in valgus stability.

The acceleration phase of an overhead throw causes the greatest amount of valgus stress on the elbow – while the forearm lags behind the upper arm and creates valgus stress. This leaves the elbow primarily dependent on the anterior band of the UCL for stability. The extreme acceleration can cause the valgus force to overcome the tensile strength of the UCL and result in either chronic microscopic tears or an acute rupture.

Tearing of the ligament generally occurs after a period of localized internal soreness around the elbow. When the tear occurs, patients report feeling a “pop” followed by weakness and inability to function properly.

Those at Risk
Athletes regularly subjecting their elbow to high acceleration activities in flexion and extension are likely to incur this type of injury.

Diagnosis
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of pain may have an X-ray performed, while those experiencing deep sharp pains – particularly during a sport activity – may require magnetic resonance imaging (MRI).

Treatment
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in position for an athlete, while the damage is assessed. A course of conservative treatment followed by rehabilitation is generally the first phase of addressing an injury or condition.

When a tear or rupture requires surgery, an exploratory arthroscopy is generally performed to confirm no other damage. And a surgery popularized by a former major league pitcher, Tommy John, called the Tommy John surgery may be necessary. The procedure – known to doctors as ulnar collateral ligament reconstruction – takes only an hour and returns full strength to the elbow and forearm by replacing the damaged ligament with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).

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