Elbow treatment has advanced since days of Tommy John

In 1974, a baseball player named Tommy John underwent the first successful reconstruction of the elbow ulnar collateral ligament, or UCL. The importance in this fact lies in the understanding that until that time, injuries to that ligament were career ending for baseball players. Since that time, treatment of this injury has advanced and the type of athletes that have UCL injuries has spread.

The UCL is on the inner side of the elbow and attaches the lower arm bone (humerus) to the bigger of the two forearm bones (ulna). This ligament is most commonly injured in throwing athletes, but can be injured in any athlete who uses the elbow to bear weight (wrestling or gymnastics) or who has sustained an elbow dislocation. The injury is uncommon in patients who are still growing (because injury to the growth plate is more common); however, it can happen.

If the injury is chronic in nature, then it most commonly arises from overuse. With repetitive stress the ligament can become loose or injured. The looseness, or instability, of the elbow can compound and create more injury to the ligament eventually leading to a tear of the UCL.

To prevent the repetitive injury from occurring, the only solution is to limit the repetition. If your child is a pitcher, then limit the pitches. Moreover, some throwers have poor mechanics and this can lead to injury, as well. Education on good technique is important, especially at a young age. Learning to throw with the core and trunk muscles and letting the arm be relatively more passive will limit the amount of stress seen at the elbow. Using the arm and elbow to create velocity itself will increase the risk of injury.

Signs and symptoms of elbow instability include: pain on the inner side of the elbow with throwing or pushing up from a seated position, swelling at the elbow, or a decrease in ability to throw the ball as fast or as accurately. X-rays are important to be sure that there is no fracture (this is much more common in kids), but an MRI will be important to assess the ligaments and look for other injuries in the joint, if the X-ray is normal.

Treatment of a UCL injury can be conservative if the tear is incomplete. This involves stopping all throwing (including any throwing outside organized sports) and resting the elbow. Moreover, physical therapy can be utilized to improve the strength of the muscles around the elbow, and improve throwing mechanics.

A complete tear, or a partial tear that does not respond to conservative treatment, usually requires surgery for someone who wants to continue in a sport. The elbow is a very stable joint. So, even if the UCL tear resulted from a dislocation, the UCL is not necessary to keep the elbow from coming out of place. Most people can function and perform regular daily activities without the UCL. However, if there is a sense of instability even with regular daily activities, then surgery may be an option.


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