The ulnar collateral ligament, or UCL, is the lament of many throwing athletes and overhead workers. Years of overuse and poor mechanics cause even the strongest patients to sustain injuries and medial elbow pain, and the numbers are quickly increasing. When it’s too late for preventative measures, clinicians are tasked with devising a complete plan of attack to get patients back to activity as soon (and as safely) as possible. Luckily for you, we’re here to help. In this installment of the Injury Management Series, we’ll give you the lowdown on UCL injuries, what to expect and the best treatment options to consider.
UCL Injury Overview
Let’s Start with a Quick Refresher: What is the UCL?
The UCL is “a small ligament on the inner portion of the elbow that provides stability to resist valgus force (angulation) at the elbow joint.” 1 This ligament is comprised of three sections:
- The anterior bundle is divided into anterior (extension) and posterior (flexion) sub-sections and is the strongest component UCL stabilization.
- The posterior bundle kicks in as a backup stabilizer when the joint flexes beyond 90°.
- The transverse bundle is least commonly used and does not play a role in elbow stability.
Injury Mechanics and Symptoms
There are two main causes of UCL injuries. The first, and most common, is repetitive stress. These injuries occur over a longer period of time and under gradual stretching of the ligament or degradation of the tissue from repeated significant forces across the elbow joint. 1 The onset of pain is slow, and the damage to the ligament is equally gradual. The second mechanism of injury is acute trauma. In a situation like a collision or other sudden force, the UCL can rupture. The onset of pain and dysfunction is immediate.
After sustaining a UCL injury, patients can present with symptoms such as pain along the inside of the elbow during overhead activity or tingling in the pinky and ring finger. 2 Unfortunately, patients are most at risk when they ignore these symptoms, which can be relatively easy; when not in overhead or throwing positions, UCL pain is unlikely to present in daily activity, which can cause some to delay medical attention.
For a full list of risk factors, check out this American Physical Therapy Association (APTA) in the “Can This Injury Be Prevented” section.
Populations Most at Risk
While anyone who participates in overhead activity can sustain UCL damage, the population most susceptible are athletes. Gymnasts, cheerleaders, soccer players and wrestlers have been known to suffer acute trauma to the UCL during a fall from a significant height, while baseball, softball, football, tennis and other overhead or throwing athletes are more likely to sustain their injuries from repetitive stress over the years. In fact, medial elbow symptoms account for 97% of elbow complaints in pitchers. 3
“What’s happened is that it all comes down to overuse: overuse with mechanics that are poor,” said Andre Labbe PT, MOMT, a sports physical therapist and researcher based in New Orleans, Louisiana. “What’s happened is, year-round baseball has caused us to create a dilemma and epidemic of overuse injuries in very young players. A player that graduates high school today has probably played as much baseball as some of our college or pro players from 15-20 years ago.”
Traditional UCL Rehabilitation and Some Notable Emerging Tech to Try
Rehabilitation methodology is “based upon the type of activity of the patient or type of sport or even the specific position, as well as the mechanism of injury, location of the tear, and the integrity of the remaining ligament.” 1 The good news for clinicians treating patients with UCL injuries? You have a few options to choose from. Here are some common treatment avenues to heal patients of any age.
Surgical Treatment Methods
For major acute injuries or repetitive injuries that have resulted in a full tear, surgical intervention may be the best method of treatment. UCL reconstruction, better known as Tommy John Surgery, is the routine procedure.
Another option is revision UCL reconstruction, which carries results less favorable to traditional reconstruction due to lower return to sport rates, decreased performance and shorter career lengths. 4
Non-Surgical Treatment Options
Some hands on healthcare professionals, like Labbe, have been searching for new methods of treating UCL injuries that don’t require going under the knife. Non-surgical interventions have been shown to have great success, like:
- A break from activity
- Inflammation-reducing aids, such as nonsteroidal anti-inflammatory medications, ice and topical analgesics
- Manual therapy
- Strengthening exercises
- Range of motion and movement correction exercises
Alongside physical therapy, a recent study explored the use of biologic injections to achieve superior results.
“What’s interesting now in our treatment of ulnar collateral ligament strains, sprains tears and with Tommy John is we’re finding out that we’re trying not to do as much surgery as we have in the past,” said Labbe. “With partial tears we’re getting a lot of good results with PRP and stem cell injections. The reality of the situation is that agents, parents and everyone think ‘well, when you come back from [Tommy Johns surgery], you’re just as good or better,’ But, statistically, they never reach the velocity they could ever have before. As soon as we cut open a kid or an athlete, they are never going to reach the potential they could have before surgery.”
Expert UCL Rehabilitation Exercises
After a career of working with elite overhead athletes, Labbe has perfected UCL rehabilitation by choosing exercises that challenge the entire posterior chain and aim at creating a more holistic stability throughout the body. His theory? It’s all in the hips.
All you’ll need is a TheraBand CLX Band, a CLX Door Anchor and some Stability Trainers!
Save and use this PDF to incorporate these exercises into your practice for patients of all ages!
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