Medial collateral ligament (MCL) injuries most often occur when the elbow is subjected to the high velocity pitches attained by amateur and professional pitchers, who may throw balls reaching speeds between 70 and 100 miles an hour. This level of throwing places a significant amount of force on the elbow joint that over time can lead to irritation, inflammation, cartilage tears, formation of bone spurs and eventually tearing of the MCL.
The MCL is part of a network of ligaments and tendons that attach and help stabilize at the elbow the bones of the lower (ulna and radius) and upper (humerus) arm.
When the MCL is torn, athletes usually maintain full range of motion and the ability to throw, but with significantly reduced force. While often times a “pop” is reported with the ligament tears, it can also be a gradual process and go undetected for a period of time.
Those at Risk
Baseball players, particularly pitchers, are most often diagnosed with this injury as a result of the frequent and irregular force exerted on their elbow joint.
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of performance disruption may have an X-ray, while those experiencing a sharp “pop” – particularly during a throw – may require magnetic resonance imaging (MRI).
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in field 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 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 indicated. The procedure – known to doctors as medial collateral ligament reconstruction – takes only an hour and returns full strength to the elbow by replacing a ligament in the medial elbow with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).