The ulnar collateral ligament, commonly abbreviated as UCL, is prone to injuries due to the repeated stress caused by overhead movement. The people who often suffer UCL injuries are sports people who participate in throwing sports like javelin and baseball. Ligaments consist of strong bands that hold the bones together, controlling the joint movement. The ligaments act as tethers between the elbow bones. The bone moves too much when you have a torn ligament since the tether is too long.
Some of the common symptoms of a torn ligament include constant pain, looseness in the elbow joint, a sense of instability in the joint, and an inability to play sports or work out. If you have a torn ulnar collateral ligament injury in Las Vegas, we invite you to contact Suarez Physical Therapy. Our experienced physical therapists will create an ideal treatment plan to restore the full functionality of your elbow joint.
The Ulnar Collateral Ligament
The ulnar collateral ligament (UCL) lies inside the elbow on the medial side. One side of the ligament attaches to the humerus, while the other connects to the ulna. The humerus is the bone of your upper arm, while the ulna is the forearm bone. A UCL has three divisions or bands: the front (anterior) and back (posterior), and across (transverse) bands. The elbow's functionality and stability are highly dependent on the anterior band.
The Leading Causes Of UCL Injuries
You can suffer a UCL injury in various ways. In most cases, UCL injury occurs gradually due to the repeated stress on the ligament. The gradual injury mainly occurs in athletes who engage in throwing sports or sports that involve overhead arm use. UCL injuries are common in children, especially baseball pitchers below 15 years. Injuries in children also occur gradually, like in adult players. If a child experiences pain while throwing, you should address it immediately. Addressing the pain immediately helps to prevent further injuries.
You should not confuse a UCL injury with a little league elbow, a common injury among young baseball players. Like the UCL injury, the Little League elbow also results from overuse of the elbow joint. The Little League elbow does not occur on the ligaments. Instead, it appears on the growth plates located on the ends of the bones that form the elbow joint.
You could suffer a traumatic UCL injury if you fall on an outstretched arm. A fall could rupture the UCL or have it pulled off the humerus. In addition, traumatic UCL injuries could cause chipping of the bone, commonly known as an avulsion fracture, even if this is rare. Most traumatic UCL injuries are accompanied by elbow fracture or dislocation.
Common Symptoms Of A UCL Injury
It is essential to understand the symptoms of a UCL injury so that you can tell whenever you suffer an injury. The signs to look out for are:
- You could experience a sudden pop or pain inside your elbow, making it challenging to continue throwing
- After a period of overhead activity or heavy throwing, you could experience pain inside your elbow.
- You could experience pain as you accelerate your arm forward, preparing to release the ball.
- Numbness or tingling in your pinky or ring fingers, or both
Upon suffering a UCL injury, you will have a hard time participating in sports that involve throwing because of the instability that results from a UCL tear. However, a UCL injury will hardly affect your ability to participate in your routine activities like doing household chores or carrying a bag of groceries. In addition, a UCL tear will not prevent you from participating in non-throwing activities like running or lifting weights.
UCL Injuries Diagnosis
Diagnosing a UCL injury is usually more complicated than treating the injury. A sports medicine expert or an orthopedic specialist diagnoses and treats UCL injuries. An expert can rely on history or physical examination to diagnose a UCL tear. The best way to assess the condition of the injury is through a valgus test. A valgus test involves testing a patient’s elbow for instability.
A specialist could also perform an x-ray or an MRI scan to check for changes in the ulnar collateral ligament. However, experts rarely rely on x-rays and MRIs as the sole tests for diagnosing a UCL injury. An MRI scan could show a UCL tear. However, an MRI scan is not 100% accurate. Your doctor can increase the accuracy of an MRI scan by injecting gadolinium (dye) into the elbow joint before performing the scan.
The Treatment For UCL Injuries
Your doctor can recommend surgical or non-surgical treatment of UCL injury. The appropriate treatment option will depend on your goals. For example, the non-surgical treatment would not be effective if you intend to return to throwing sports or other overhead strenuous activities. In this case, your physician will advise you to undergo a surgical repair of the torn UCL.
Non-surgical Treatment Methods
The non-surgical UCL treatment helps to relieve pain and stabilizes the elbow joint. The common non-surgical treatment methods for UCL injuries are:
- An initial period of rest
- Your doctor could recommend anti-inflammatory medication, usually non-steroidal options like Ibuprofen, aspirin, and naproxen.
- The doctor could also advise you to apply ice to your elbow daily until the swelling and the pain is gone.
- You could begin physical therapy when the inflammation subsides. Physical therapy will help to strengthen the muscles around the elbow, which will, in turn, compensate for the torn ligaments.
Also known as Tommy John surgery, UCL reconstruction involves using a tendon taken from another part of the body to serve as the new ligament. Your doctor could also use a tendon acquired from a donor. The doctor drills tunnels in your ulna and humerus to hold the new graft (tendon). The doctor could attach the remains of the original ligament to the graft to make it stronger.
Recovery From A UCL Injury
How long you take to recover from a UCL treatment will vary depending on the treatment method used. If you do not undergo surgery to treat a UCL injury, the recovery period could be several weeks to several months. The ideal treatment option (surgical or non-surgical) will depend on the range of motion you intend to achieve with your elbow. Your physical therapist and your doctor will work together to check your progress.
If you undergo surgery to treat a UCL injury, the recovery or rehabilitation could take between nine months and one year. At times, the recovery period will extend beyond one year. Your doctor will place your elbow in a hinged brace to enhance its range of motion until you can fully extend the elbow. You will need rigorous physical therapy to ensure that your elbow is strong enough if you intend to return to throwing.
Physical therapy will give your elbow the strength required to handle the stress of throwing sports. The recovery period will vary from person to person because everyone recovers at their pace. However, you should never rush to return to sports until you fully recover. If you exert too much pressure on the graft before it recovers, you increase the risk of treatment failure.
Whether A UCL Injury Can Heal Itself
If you suffer a minor ulnar collateral ligament injury, the injury can heal itself without surgical treatment. However, if you intend to perform a strenuous throwing or overhead activity, your doctor could recommend surgical treatment of the torn ligament. Surgical treatment could also come in handy if your elbow has an advanced grade tear. In a case of minor UCL injury, the following steps could help reduce inflammation, relieve pain, and stabilize your elbow:
Get Enough Rest
When you have a torn UCL, you will heal better in a neutral position. Therefore, ensure that you get ample rest. You should also avoid splints and hand movements during the recovery period.
Apply Ice Pack To The Elbow
You can soothe the pain in your elbow by applying an ice pack daily. Applying ice to the injured elbow will also help to reduce inflammation.
If you have pain and discomfort due to a torn UCL, your doctor could recommend pain relievers like Ibuprofen, naproxen, and aspirin.
You should start physical therapy sessions once the swelling and inflammation go down. Physical therapy will help strengthen the muscles around your elbow, which will compensate for the torn ligaments. Other conservative methods recommended for mild UCL injuries are:
- Activity restriction
- Pulsed ultrasound that helps to increase blood flow to the injured ligament to promote healing
Most mild UCL injuries get better without surgery. However, UCL reconstruction surgery will be necessary if the conservative treatment methods do not work and the injury does not resolve within 6 and 12 months. Unless you are a professional or collegiate athlete, the doctor will most likely recommend conservative treatment for UCL injury. Surgical reconstruction is often performed if a patient intends to continue their sport.
What You Should Expect After A UCL Reconstruction Surgery
A Tommy John surgery is performed in an operating room, usually under regional or general anesthesia. When performing the surgery, the physician is careful to move tendons, muscles, and nerves. After drilling holes in the ulna and humerus, the doctor inserts the donor tendons through the holes in a figure 8 pattern. The doctor then closes the incision and covers it with sterile dressings. The doctor finally applies a splint to the elbow flexed at 90 degrees.
Your surgeon will give you the guidelines to follow after reconstruction surgery. The instructions will depend on the repair performed and the surgeon's preference. The typical guidelines are:
- You should ensure that you elevate your arm to minimize swelling
- Wear a cast or an immobilizing splint for one to three weeks
- Apply ice packs or cold compress to the surgical site to reduce swelling
- Ensure that the surgical site is always clean and dry. When showering or bathing, you should cover the area with plastic wrap.
- The surgeon will recommend physical therapy. Physical therapy will involve stretching and strengthening exercises after removing the cast or the splint.
- Professional athletes should expect rigorous physical therapy sessions for six to twelve months before finally returning to their sports.
- The doctor will also advise you to eat a healthy diet and avoid smoking to promote healing
Risks And Complications Of A UCL Reconstruction Surgery
As with any other type of surgery, a Tommy John surgery has potential complications. Most patients do not suffer any complications after a UCL reconstruction surgery. Some of the possible complications that could occur after a UCL surgery are:
- Limited range of motion
- Cubital Tunnel Syndrome
- Nerve damage could cause tingling, numbness, burning sensation, loss of feeling in the hand and the forearm area.
- Elbow instability
Physical Therapy For UCL Injuries
It is advisable to seek medical help if you have signs of a UCL injury, including pain, numbness, or instability in the elbow joint. Your doctor could refer you to a physical therapist, especially if medical intervention is unnecessary. Before commencing treatment, the physical therapist will conduct a thorough evaluation and diagnosis, including examining your health and activity history. Some of the questions that the physical therapist will ask are:
- When and how the UCL injury occurred — The therapist will seek to know whether the injury occurred gradually or suddenly.
- How long you have had the pain
- Whether you experience numbness and tingling in your arm
- Whether you often feel a pop in the elbow whenever you throw or perform an overhead activity
- Whether you experience instability or a feeling of giving out when engaging in an overhead activity
- The types of activities or sports that you usually participate in
- Whether you have experienced a decrease in sports or job performance
- If you have had to stop playing a sport or performing your job because of an elbow injury.
The physical therapist will touch and examine the area around your elbow to locate the specific injury site. The physical therapist could also tell you to slightly bend your arm as you mimic a throwing action or motion as he/she applies pressure on the outside of your elbow joint.
In some instances, a physical therapist could collaborate with an orthopedic surgeon. For example, the surgeon could order additional tests like MRI (magnetic resonance imaging) or an MRA (magnetic resonance arthrogram). These tests will help confirm that you have suffered a UCL injury and enable the physical therapist to rule out other possible causes of elbow pain and discomfort.
How A Physical Therapist Will Help
Your physical therapist will come in handy whether you undergo a UCL reconstruction surgery or not. A therapist will help improve your range of motion and restore your arm’s strength. Even after surgery, your physical therapist will work with you, allowing you to identify issues that could have contributed to the injury. The common contributors to UCL injuries are:
- Improper throwing mechanics
- Strength deficits
- Range of motion
When you know the initial cause of UCL injury, you can prevent the injury from recurring. Below are the benefits you will reap from a physical therapist:
Enhance Your Recovery Process
The best way to promote the healing of a UCL injury is by reducing the stress exerted on the injured area. Your therapist will likely advise you to take a break from sports or overhead activities. The therapist could also educate you on rest, ice, compression, and elevation principle, commonly abbreviated as RICE. The therapist could also implement cross-friction massage to enable your body to supply essential vitamins to the injured ligaments.
Strengthening Your Muscles
Your arm will feel weaker after a UCL injury. The physical therapist will aim to decrease pressure or stress at your elbow joint by strengthening the muscles of your shoulders, shoulder blades, and upper back. The physical therapist could also address lower back weakness and body balance through the trunk and the hips to decrease the pressure on the elbow.
Improving Your Range Of Motion
You will notice more difficulty bending or strengthening your arm after a UCL injury. Your physical therapist will work with you to improve your arm's range of motion.
The therapist could stretch your shoulder to reduce stress on your elbow as you perform overhead activities.
Correcting Your Movements
Every sport calls for different arm positions. Some arm positions could put you at a higher risk of UCL injury. A physical therapist will examine and help you to modify the movements you usually perform to enable you to return safely to your sport. Your therapist will create a specific program to allow you to return to full activity gradually.
Helping You To Return To Sports
If you plan to return to sports after a UCL injury, you should prepare your arm to withstand stress while throwing or engaging in overhead motions. Your therapist will work with you to create and implement a suitable program to help you return to sporting.
If you undergo a UCL reconstruction surgery, your arm will likely be placed in a brace, splint, or sling to protect the elbow. Usually, you will begin physical therapy sessions the first week to ten days after surgery. A physical therapist will help you improve your arm's strength by improving how far you can move your elbow and shoulder. Eventually, you will resume sport-specific activities and even return to full competition.
Find An Experienced Las Vegas Physical Therapist Near Me
A UCL injury could significantly alter your life, especially if you are a sportsperson. If you suspect a UCL injury, it is advisable to seek immediate medical attention. A common treatment for UCL injuries is physical therapy. For reliable physical therapy services in Las Vegas, contact Suarez Physical Therapy. Call us at 702-368-6778 and talk to one of our physical therapists.