Ulnar Collateral Ligament Injury of the Elbow

Ulnar Collateral Ligament Injury of the Elbow



Description


Ulnar collateral ligament injury of the elbow is a sprain (tear) of one of the ligaments of the inner elbow. The ulnar collateral ligament (UCL) helps maintain the normal relationship between the upper arm bone (humerus) and one of the forearm bones (ulna). The UCL is injured in throwing sports or after elbow dislocation or elbow surgery. It may occur as a sudden tear or may gradually stretch out over time with repetitive injury, but this ligament is rarely stressed in daily activities. The UCL prevents the elbow from gapping apart on the inner side. When torn, this ligament usually does not heal, or it may heal in a loosened, lengthened position. Sprains are classified into three grades: in a first-degree sprain, the ligament is not lengthened, but it is painful; with a second-degree sprain, the ligament is stretched but still functions; with a third-degree sprain, the ligament is torn and does not function.



Common signs and symptoms



• Pain and tenderness on the inner side of the elbow, especially when trying to throw

• A popping, tearing, or pulling sensation noted at the time of injury

• Swelling and bruising after 24 hours at the site of injury at the inner elbow and upper forearm with an acute tear

• Inability to throw at full speed and loss of ball control

• Elbow stiffness and inability to straighten the elbow

• Numbness or tingling in the hand and in the ring and little fingers

• Clumsiness and weak grip


Causes


Ulnar collateral ligament injury is caused by a force that exceeds the strength of the ligament, and it is usually the result of hard or repetitive throwing. It may occur with an elbow dislocation or as a result of surgery.



Factors that increase risk



• Contact sports (football, rugby) and sports in which falling on an outstretched hand results in an elbow dislocation

• Throwing sports (baseball, javelin)

• Overhead sports (volleyball, tennis)

• Poor physical conditioning (strength, flexibility)

• Improper throwing mechanics


Preventive measures



• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes arm, forearm, and wrist flexibility and muscle strength and endurance training.

• Use proper protective technique when falling and throwing.

• Functional braces may be effective in preventing injury, especially reinjury, in contact sports.


Expected outcome


The UCL usually does not heal sufficiently on its own with nonoperative treatment. To return to throwing sports, surgery is often necessary.



Possible complications



• Frequent recurrence of symptoms, such as an inability to throw at full speed or distance, pain with throwing, and loss of ball control, especially if activity is resumed too soon after injury

• Injury to other structures of the elbow, including the cartilage of the outer elbow and the ulnar nerve of the hand

• Medial epicondylitis and strain of the muscle–tendon structures that bend the wrist

• Injury to articular cartilage, resulting in arthritis of the elbow

• Elbow stiffness and loss of elbow motion

• Loose pieces of bone or cartilage floating in the elbow


General treatment considerations


Initial treatment consists of medications and ice to relieve pain and reduce swelling of the elbow and stopping participation in the sport that caused the injury. Occasionally a splint, brace, or cast may be recommended while the acute phase subsides. Later, rehabilitation to improve strength, endurance, and proper throwing mechanics is initiated. This may be carried out at home, although referral to a physical therapist or athletic trainer is usually recommended, and a gradual return to throwing is attempted. For athletes who have an acute rupture of the ligament or for those who have failed therapy and wish to continue throwing competitively, surgical reconstruction that involves rebuilding the ligament using other tissue is usually recommended. Returning to sports without surgery may take 3 to 6 months and may take 6 to 18 months following surgery.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed as necessary. Use these only as directed.


Heat and cold



• Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage. Use a towel between the ice and your elbow to reduce the chance of cold injury to the ulnar nerve at the inner elbow.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


When to call your doctor



• Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

• You experience pain, numbness, or coldness in your hand.

• A blue, gray, or dusky color appears in your fingernails.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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Figure 1


From Shankman GA: Fundamental orthopedic management for the physical therapy assistant, St Louis, 1997, Mosby Year Book, p 274.

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Jul 18, 2016 | Posted by in SPORT MEDICINE | Comments Off on Ulnar Collateral Ligament Injury of the Elbow

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