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Ulnar Collateral Ligament Tear


What is the Ulnar Collateral Ligment (UCL)?


The ulnar collateral ligament complex (UCL) is located on the inside (medial side) of the elbow.  It is made up of three bands, the anterior, posterior, and transverse bands.  It attaches from the humerus (upper arm bone) to the coronoid process of the ulna (a bone in the forearm).


The anterior band of the UCL is the primary restraint to stress to the elbow. The largest stresses to the medial elbow can occur with rotational movements, like throwing a baseball.


How is the UCL injuried?


Most commonly, repetitive stresses on the ligament can cause micro-trauma, with pain worsening over time.  For overhead or throwing athletes, inflexibility, fatigue or poor mechanics can lead to injury and increased stress on the UCL. 


Gradual stress over time cause the ligament to stretch and become too long, making it no longer able to hold the bones together properly.  Less commonly, you may feel pain or a “pop” along the medial elbow with one particular throw or a single event.


What are the symptoms of a UCL tear?


You may feel pain along in the inside of you elbow, especially when throwing.  You will still likely be able to perform regular daily activities, and even exercise or lift weights.  A UCL tear usually is only symptomatic in positions that stress the medial elbow, like pitching or throwing a football.


How is a UCL tear diagnosed?


Your physician will perform a throughout history and physical examination.  Part of the exam will involve stressing the elbow to assess for pain or looseness of the ligament.  An X-ray and MRI may also be needed to assess the ligament further.


How is a UCL tear treated?


Treatment options depend upon your goals and the extent of the tear.  Usually joint stability and pain control can be obtained with a nonsurgical plan, including anti-inflammatory medication, bracing and physical therapy with a throwing program.


If you wish to return to throwing or overhead sports, and you do not respond to conservative treatment, then a surgical procedure may be indicated to either repair or reconstruct the torn ligament.  Direct repair is only an option if the ligament torn directly off the bone, which is not that common.  More commonly, the UCL tears in the midsection and needs to be reconstructed with graft tissue, which is commonly known as a Tommy John Procedure.


How long does it take to recover after surgery?


After surgery, your elbow will be immobilized in a splint for 1-2 weeks.  Then, you will gradually regain your motion over 6-8 weeks.  Once your motion has returned, you will then begin strengthening exercises, and slowly progress to sports-specific exercises such as a interval throwing program.  Typically, it can take 8-9 months to be able to return to full, unrestricted throwing or overhead activities. 


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