Ulnar collateral ligament (elbow)
Encyclopedia
The ulnar collateral ligament (internal lateral ligament) is a thick triangular band consisting of two portions, an anterior and posterior united by a thinner intermediate portion.
. At first, pain can be bearable and can worsen to an extent where it can terminate an athlete’s career. The repetitive stress placed on the ulna
causes micro tears in the ligament resulting in the loss of structural integrity over time. The acute rupture is less common compared to the slow deterioration injury. The acute rupture occurs in collisions when the elbow is in flexion
such as that in a wrestling match or a tackle in football. The ulnar collateral ligament distributes over fifty percent of the medial support of the elbow. This can result in an ulnar collateral ligament injury or a dislocated elbow causing severe damage to the elbow and the radioulnar joints.
pitchers and javelin throwers because the throwing motion is similar. Gridiron football
, racquet sports, ice hockey
and water polo
players have also been treated for damage to the ulnar collateral ligament. Injuries to the Ulnar Collateral Ligament are believed to result from poor throwing mechanics, overuse, high throwing velocities, and throwing certain types of breaking pitches. Injuries to the Ulnar Collateral Ligament in baseball players are rarely due to one-time, traumatic events. Rather, they are more often due to small tears that accumulate over time.
is $21,563.
test. The valgus stress test is performed on both arms and a positive test is indicated by pain on the affected arm that is not present on the uninvolved side. Physicians often utilize imaging techniques such as musculoskeltetal ultrasound, x-rays and magnetic resonance imaging
or arthroscopic surgery to aid with making a proper diagnosis.
is the main symptom of this condition. Throwing athletes report it occurs most often during the acceleration phase of throwing. Closing the hand and clenching the fist has also been shown to reproduce the painful symptoms. The injury is often associated with an experience of a sharp “pop” in the elbow, followed by pain during a single throw. In addition, swelling and bruising of the elbow, loss of elbow range of motion
, and a sudden decrease in throwing velocity are all common symptoms of a UCL injury. If the injury is not as severe, pain can be minimal with complete rest.
In the instance of choosing to not have the surgery, patients are instructed to follow the RICE
(Rest, ice, compression, elevation) method while using NSAIDS (Non-steroidal anti-inflammatory drug) to help alleviate pain and swelling. When the swelling has subsided, individual exercises or physical therapy may be prescribed to assist in the recovery process. The goal in these instances is to strengthen the muscles around the elbow joint to compensate for the torn UCL ligament. Some of these exercises may include biceps
curls (non resistance and resistance), pronating and supinating the forearm, and grip strengthening exercises. These exercises are performed with low resistance and a moderate amount of repetitions at no more than three times a week.
Opting for the surgical treatment provides the possibilities of regaining the abilities to perform the overhand throwing motions most commonly associated with UCL injuries. Typically, two types of tissue may be used for the reconstructive surgery by using autograft or allograft tissues. Autograft tissue is, in most cases, the palmaris longus tendon, which is mostly seen as an accessory tendon. An allograft is when the tissue comes from a cadaver, or donor. Attachment of the new tendon is done by drilling holes known as “tunnels” in the medial epicondyle of the humerus
and the sublime tubercle of the ulna. The tendon will then be laced through the tunnels in a figure eight pattern. Following the surgery, the patient may begin physical therapy
shortly after.
- The anterior portion, directed obliquely forward, is attached, above, by its apex, to the front part of the medial epicondyleMedial epicondyleMedial epicondyle can refer to:* Medial epicondyle of the humerus * Medial epicondyle of the femur...
of the humerusHumerusThe humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow....
; and, below, by its broad base to the medial margin of the coronoid processCoronoid processThe Coronoid process can refer to:* The coronoid process of the mandible, part of the ramus mandibulae of the mandible...
. - The posterior portion, also of triangular form, is attached, above, by its apex, to the lower and back part of the medial epicondyle; below, to the medial margin of the olecranonOlecranonThe olecranon is a large, thick, curved bony eminence of the forearm that projects behind the elbow.It is situated at the upper end of the ulna, one of the two bones in the forearm...
.
- Between these two bands a few intermediate fibersIntermediate fibersIntermediate fibers, also known as fast oxidative-glycolytic fibers, are fast twitch muscle fibers which have been converted via endurance training. These fibers are slightly larger in diameter, have more mitochondria as well as a greater blood supply and more endurance than typical fast twitch...
descend from the medial epicondyle to blend with a transverse band which bridges across the notch between the olecranon and the coronoid process.
- This ligament is in relation with the Triceps brachii and Flexor carpi ulnaris and the ulnar nerveUlnar nerveIn human anatomy, the ulnar nerve is a nerve which runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest unprotected nerve in the human body , so injury is common...
, and gives origin to part of the Flexor digitorum superficialis.
Classification of the UCL injury
Ulnar collateral ligament injury can be classified into two categories a slow deterioration injury or an acute rupture. The slow and chronic deterioration can be due to repetitive stress acting on the ulnaUlna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...
. At first, pain can be bearable and can worsen to an extent where it can terminate an athlete’s career. The repetitive stress placed on the ulna
Ulna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...
causes micro tears in the ligament resulting in the loss of structural integrity over time. The acute rupture is less common compared to the slow deterioration injury. The acute rupture occurs in collisions when the elbow is in flexion
Flexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
such as that in a wrestling match or a tackle in football. The ulnar collateral ligament distributes over fifty percent of the medial support of the elbow. This can result in an ulnar collateral ligament injury or a dislocated elbow causing severe damage to the elbow and the radioulnar joints.
Causes of UCL injuries
Damage to the ulnar collateral ligament is common among baseballBaseball
Baseball is a bat-and-ball sport played between two teams of nine players each. The aim is to score runs by hitting a thrown ball with a bat and touching a series of four bases arranged at the corners of a ninety-foot diamond...
pitchers and javelin throwers because the throwing motion is similar. Gridiron football
Gridiron football
Gridiron football , sometimes known as North American football, is an umbrella term for related codes of football primarily played in the United States and Canada. The predominant forms of gridiron football are American football and Canadian football...
, racquet sports, ice hockey
Ice hockey
Ice hockey, often referred to as hockey, is a team sport played on ice, in which skaters use wooden or composite sticks to shoot a hard rubber puck into their opponent's net. The game is played between two teams of six players each. Five members of each team skate up and down the ice trying to take...
and water polo
Water polo
Water polo is a team water sport. The playing team consists of six field players and one goalkeeper. The winner of the game is the team that scores more goals. Game play involves swimming, treading water , players passing the ball while being defended by opponents, and scoring by throwing into a...
players have also been treated for damage to the ulnar collateral ligament. Injuries to the Ulnar Collateral Ligament are believed to result from poor throwing mechanics, overuse, high throwing velocities, and throwing certain types of breaking pitches. Injuries to the Ulnar Collateral Ligament in baseball players are rarely due to one-time, traumatic events. Rather, they are more often due to small tears that accumulate over time.
Epidemiology of the UCL injury
According to the International Classification of Diseases, 9th Revision, Clinical Modification, ICD-9-CM, in 2008 the U.S. listed the diagonsis code for UCL injury as 841.1: Sprain ulnar collateral ligament. There were a total of 336 discharges of UCL injuries. Within the total discharges, separated by age groups: 18-44 year olds; 165 people (49.17%). 45-64 year olds; 91 (27.08%). 65-84 year olds, 65 (19.35%) it shows that the ulnar collateral ligament injuries were more commonly found in men than women. There were 213 men compared to 123 women with ulnar collateral ligament injury. Most of these injuries were also paid through private insurance (170: 50.63%) and Medicare (70: 20.85%). The average estimated cost for the surgery also known as Tommy John SurgeryTommy John surgery
Tommy John surgery, known in medical practice as ulnar collateral ligament reconstruction, is a surgical procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body...
is $21,563.
Diagnosis of the UCL injury
If symptoms of an ulnar collateral ligament injury are present, one should seek a physician’s consultation in order to have a proper diagnosis. In most cases, a physician will diagnose an ulnar collateral ligament injury using a patient’s medical history and a physical examination that includes a procedure known as the valgus stressValgus stress
The Valgus stress test is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus...
test. The valgus stress test is performed on both arms and a positive test is indicated by pain on the affected arm that is not present on the uninvolved side. Physicians often utilize imaging techniques such as musculoskeltetal ultrasound, x-rays and magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
or arthroscopic surgery to aid with making a proper diagnosis.
Signs & Symptoms of the UCL injury
Pain along the inside of the elbowElbow
The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....
is the main symptom of this condition. Throwing athletes report it occurs most often during the acceleration phase of throwing. Closing the hand and clenching the fist has also been shown to reproduce the painful symptoms. The injury is often associated with an experience of a sharp “pop” in the elbow, followed by pain during a single throw. In addition, swelling and bruising of the elbow, loss of elbow range of motion
Range of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
, and a sudden decrease in throwing velocity are all common symptoms of a UCL injury. If the injury is not as severe, pain can be minimal with complete rest.
Treatments of the UCL injury
The treatment of a UCL injury can follow the path of receiving surgical treatment or opting to not receive surgical treatment. Non surgical treatment will primarily focus on strengthening the elbow joint to regain strength and stabilize the joint.In the instance of choosing to not have the surgery, patients are instructed to follow the RICE
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
(Rest, ice, compression, elevation) method while using NSAIDS (Non-steroidal anti-inflammatory drug) to help alleviate pain and swelling. When the swelling has subsided, individual exercises or physical therapy may be prescribed to assist in the recovery process. The goal in these instances is to strengthen the muscles around the elbow joint to compensate for the torn UCL ligament. Some of these exercises may include biceps
Biceps
Biceps may refer to:*Biceps brachii muscle, a muscle located on the inside of the upper arm*Biceps femoris muscle, one of the hamstring muscles of the back of each thigh*Biceps , a point in a metrical pattern...
curls (non resistance and resistance), pronating and supinating the forearm, and grip strengthening exercises. These exercises are performed with low resistance and a moderate amount of repetitions at no more than three times a week.
Opting for the surgical treatment provides the possibilities of regaining the abilities to perform the overhand throwing motions most commonly associated with UCL injuries. Typically, two types of tissue may be used for the reconstructive surgery by using autograft or allograft tissues. Autograft tissue is, in most cases, the palmaris longus tendon, which is mostly seen as an accessory tendon. An allograft is when the tissue comes from a cadaver, or donor. Attachment of the new tendon is done by drilling holes known as “tunnels” in the medial epicondyle of the humerus
Medial epicondyle of the humerus
The medial epicondyle of the humerus, larger and more prominent than the lateral epicondyle, is directed a little backward. In birds, where the arm is somewhat rotated compared to other tetrapods, it is called ventral epicondyle of the humerus....
and the sublime tubercle of the ulna. The tendon will then be laced through the tunnels in a figure eight pattern. Following the surgery, the patient may begin physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
shortly after.