What Exactly is Injured?
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The tissue that is injured in the elbow is the ulnar collateral ligament (UCL). A ligament is a strong piece of collagen tissue that connects one bone to another. The UCL is the major stabilizer of the elbow during throwing.
What Are the Symptoms of a UCL Injury?
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The UCL can be injured during a single stressful event or it can slowly stretch out over time. Sometimes a pitcher may feel a pop in the elbow during a pitch followed by the immediate onset of pain, swelling, and possibly bruising. The more common presentation, however, is an insidious onset of symptoms that include pain during throwing that may result in a loss of pitch velocity and accuracy.
How is a UCL Injury Diagnosed?
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Most people will have tenderness on the medial side of the elbow. Other causes of tenderness include medial epicondylitis (golfer’s elbow) and ulnar neuropathy (cubital tunnel syndrome). Athletes with a UCL tear will have a positive “moving valgus stress” test which is an exam that can be done in the office by a trained sports medicine specialist. This test basically mimics the stress that is placed on the elbow during throwing and reproduces the pain that is experienced by the patient. In addition to a good physical exam, stress x-rays and an MRI are usually obtained to confirm the diagnosis.
How is a UCL Injury Treated?
If a partial injury is diagnosed, most UCL tears can be treated without surgery. This involves a period of rest followed by physical therapy and a progressive throwing program. This can sometimes require three months before an athlete is back to normal throwing. If a complete tear is diagnosed, most patients will require surgery. If the ligament is torn but otherwise healthy, it can be directly repaired which can allow for a more rapid recovery. These types of repairs usually occur in younger pitchers that are in high school and college.
Most major league pitchers will have such chronic changes to the UCL that a direct repair is not feasible. When this is the case, a UCL reconstruction (Tommy John surgery) is done instead. This involves replacing the torn ligament with another piece of tissue (graft) from the patient. The most common grafts used are the palmaris tendon and the gracilis tendon. The palmaris tendon is taken from the forearm while the gracilis is taken from the knee. The graft is passed into bone tunnels in the ulna (forearm bone) and humerus (upper arm bone). This outpatient surgery is performed through a 4-5 cm incision under a regional anesthetic and sedation.
How Long Does it Take to Recover from a Tommy John Surgery?
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If a UCL repair is done, the recovery time is cut in half when compared to a reconstruction. After a week-long period of immobilization, range of motion of the elbow is started while wearing a brace. The brace is typically worn for about 6 weeks. After coming out of the brace, progressive strengthening of the arm is carried out under the direct supervision of a sports-trained physical therapist familiar with this procedure. A closely monitored slow return to throwing then follows under the supervision of the surgeon, therapist, and athletic trainer. The total time to return to pitching after a direct repair of the UCL is about 6 months whereas the total time to pitching after a UCL reconstruction is about one year.
If you think you have injured your UCL, make sure that you get evaluated and treated by a sports medicine specialist that is very familiar with the treatment of Tommy John injuries. ISMI physicians are the team physicians for all BSU athletics including baseball and thus are very experienced with managing this complex injury.
To set up an appointment for further evaluation, please call (208) 336-8250.