UCL Ligament Injury

Ulnar collateral ligament (UCL) injury is experienced chiefly by baseball pitchers. This is why one of the treatments for UCL injury is named after the famous player Tommy John; hence, the surgery is called Tommy John Surgery. UCL is a strong band of tissue located on the inner side of the elbow. It provides stability during overhead movements like while throwing a ball. A fall on your overstretched arm or repetitive overhead motion may stress your UCL; this may stretch, inflame, irritate, partially or wholly tear your UCL ligament. This damage may cause loss of function, looseness in your elbow, and pain.

The mild-to-moderate symptoms of UCL ligament injury involve:

1. Clumsy/weak/shaky hand grip
2. Unsteady or weak feeling at the elbow
3. Soreness and pain on the inner side of your elbow during or after any overhead arm activity
4. Loss of ability to throw hard or fast
5. Pain with a fast forward arm movement 

Torn ligament symptoms are:

1. Severe pain
2. Numbness and tingling feeling in the ring and pinky finger 
3. Loss of ability to throw
4. Feeling an unexpected pop along the inside of the elbow

UCL injuries are common in the following sports:

1. Baseball 
2. Softball
3. Gymnastics
4. Javelin
5. Tennis

UCL injury occurs due to:

1. Trauma (hit or blow to your elbow): A fall with landing on your overstretched arm which can result in elbow fracture or dislocation that may injure the UCL.
2. Overuse, wear and tear injuries: Repetitive motion like overhand throwing strains the ligament. When the action is continued for months or years, it stretches the UCL, which breaks down the tissue from small microtears (microscopic tears in your ligament or tissue). The elbow joint gets unstable, and the UCL may become inflamed, partly or wholly torn, or one end of the ligament may get pulled away from the bone.

The main risk factor for UCL injury is:

1. Stress/strain caused by overdoing some repetitive movements.
2. By trauma due to a fall on your overstretched arm.
3. Increased pitch velocity and increased workload in players.

The diagnosis of UCL injury is difficult. Orthopaedics specialists or sports medicine experts can diagnose UCL injury and its types. UCL injuries are diagnosed by medical history and physical examination. 

1. A magnetic resonance imaging (MRI) scan, computed tomography (CT) scan and X-ray examination may be used to look at the UCL changes related to stress. Before the MRI, gadolinium (dye) may be injected into the joint to get more accurate results; this is called an arthrogram. An MRI scan shows soft tissue injuries in ligaments and tendons and can show minor fractures that are not detected in X-rays. CT and X-ray scans provide images that show fractures and other bone problems.
2. A valgus stress test is done to check the instability of the elbow and is the best test to check the UCL condition.

The treatment of UCL injury depends on its severity and how much you want to use that arm for throwing activities or strenuous movements. If the injury is minor, there are chances that it may heal itself.

The non-surgical treatment involves:

1. Ice or cold packs to your elbow to lessen the swelling and pain
2. Taking ample rest
3. Pain relievers (provided by your doctor) such as ibuprofen and naproxen 
4. Doing some physical therapy to strengthen the muscles surrounding your elbow
5. Your doctor may inject platelet-rich plasma (PRP). Your own blood will be withdrawn, and the platelets will be separated and injected into the injured area. PRP injection may help individuals with partial UCL tear.

The surgical treatment involves:

The main aim of the surgery is to restore the stability and range of motion of the elbow, lessen the pain and strengthen the elbow.

1. Direct UCL repair: If the UCL ligament is pulled off the bone due to one traumatic incident, then there is a possibility to reattach the UCL ligament.
2. Tommy John Surgery (UCL reconstruction): If your UCL is torn or unstable and the nonsurgical treatments aren’t helping control the pain; or if you are an athlete and want to continue throwing or participate in other strenuous overhead arm activities, then in such cases your doctor will recommend you Tommy John Surgery. In this surgery, your doctor will remove the tendon from other body areas or a donor and attach it to the humerus (upper arm bone) and ulna (lower arm bone); this acts as a new UCL. The other parts of the original UCL may be attached to the new graft to support and strengthen it.

Grafts (tendons) that are commonly used for reconstructing UCL are:

1. Big toe extensor tendon (helps you to move your toe)
2. Palmaris longus tendon (located at your forearm and allow you to move your wrist joint and small joints of the hand)
3. Hamstring tendon (found at the back of the thigh that helps to flex and bend your knee and rotate your leg from side to side)

If not treated in time, the injury can worsen the:

1. Inflammation of the UCL
2. Irritation at the affected site
3. Pain in the UCL
4. Instability in your elbow
5. Loss of function

Disease Progression

UCL injury is classified into three grades:

Grade 1: The UCL ligament is stretched but not torn.

Grade 2: The UCL ligament is stretched and may be partially torn.

Grade 3: The UCL ligament is entirely torn.

Usually, a UCL injury may not affect your regular activities. You may be able to lift an item, carry bags or make other non-throwing movements. However, you might not be able to do strenuous overhead exercises of the arms or repetitive or throwing activities. Therefore, it is essential to consult your doctor to identify your UCL injury grade and the appropriate course of treatment.