What is it?
Ulnar collateral ligament (UCL) injuries can occur in athletes that place a lot of stress on the elbow joint, often while throwing. A ligament is a fibrous structure that holds one bone to another, and helps to control the movement of a joint. The ulnar collateral ligament is a ligament that is located on the inside (or medial side) of the elbow (the side of the arm that is on the same side as the small finger). The ulnar collateral ligament of the elbow becomes stretched, frayed, or torn from repetitive stress on the elbow joint.

Causes
Although many people with this injury may report that it happened during a specific activity, the reality is that repeated micro-trauma to the ligament may cause degeneration over time. Ultimately, the weakened ligament may completely rupture, causing pain.

Risk Factors
This injury may occur in any one who puts a large amount of stress on his/her elbow joint. This injury most commonly occurs in baseball pitchers, but also may occur in javelin throwers and people who play racquet sports. It may also occur as a result of falling on an outstretched hand, often when the elbow is dislocated.

Symptoms

• Pain along the inside portion of the elbow is the most common symptom.

• Although not common, patients may also notice popping, clicking, or grinding in the elbow joint

Diagnosis
History and physical examination often lead the sports medicine physician to the diagnosis. X-rays may be obtained to look for any abnormalities, but often will be normal. Additional studies such as magnetic resonance imaging (MRI) may be needed to confirm the diagnosis.

Treatment
Early treatment should focus on rest, ice, and anti-inflammatory medications. A sling may also be used to help with pain. If conservative treatment followed by a graduated interval throwing program fails to improve symptoms, surgical intervention may be necessary.

Injury Prevention

• Throwing coaches may help athletes attain proper technique.

• A conditioning program that incorporates core muscle strength along with rotator cuff and forearm strengthening may help prevent injury. Stretching of the posterior capsule, or back portion of the shoulder, can also be helpful.

• Athletes who only play one sport should rest their arm at least 3 months out of the year.

Return to Play
After a few weeks of rest and non-painful rehabilitation, the patient can usually begin a graduated throwing program over several weeks, leading to a full return to sports participation.

AMSSM Member Authors: Dustin W. Lash, DO, Tracy Ray, MD

References

Kancherla VK, Caggiano NM, Matullo KS. Elbow Injuries in the Throwing Athlete.

Orthop Clin North Am. 2014 Oct;45(4):571-585

Shanley E, Thigpen C. Throwing injuries in the adolescent athlete. Int J

Sports Phys Ther. 2013 Oct;8(5):630-40