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Ulnar Collateral Ligament Sprain

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

Ulnar Collateral Ligament SprainSymptoms

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

  • A pop, 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 if there is an acute tear

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

  • Elbow stiffness; inability to straighten the elbow

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

  • Clumsiness and weakness of hand grip

Causes

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

Risk Increases With

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

  • Throwing sports, such as baseball and javelin

  • Overhead sports, such as volleyball and tennis

  • Poor physical conditioning (strength and flexibility)

  • Improper throwing mechanics

Preventive Measures

  • Appropriately warm up and stretch before practice and competition

  • Maintain appropriate conditioning:
    • Arm, forearm, and wrist flexibility
    • Muscle strength and endurance

  • Use proper protective technique when falling and throwing

  • Functional braces may be effective in preventing injury, especially re-injury, in contact sports

Prognosis

The UCL usually does not heal sufficiently on its own with non-operative treatment. To return to throwing, 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

  • Loose body formation

  • Injury to the ulnar nerve of the hand

  • Medial epicondylitis (pain and inflammation on the inner side of your elbow)

  • Strain of the muscle-tendon of the muscles that bend the wrist

  • Arthritis of the elbow from injury to cartilage

  • Elbow stiffness (loss of elbow motion)

General Treatment Considerations

Initial treatment consists of medicine and ice to relieve pain and reduce the swelling of the
elbow. You must stop participating in the sport that caused the injury. Occasionally a splint,
brace or cast may be recommended while the severe (acute) phase subsides. Later, rehabilitation
to improve strength endurance and proper throwing mechanics is initiated. This may be carried
out at home, although usually referral to a physical therapist or athletic trainer is recommended.
Gradually return to throwing. Returning to sports without surgery may take 3 to 6 months and
may take 6 to 18 months following surgery.

Surgical reconstruction (rebuilding the ligament using other tissue) is usually recommended:

  • For those who have an acute rupture of the ligament
  • When therapy has not worked and you wish to continue throwing competitively

Medication

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

  • Stronger pain relievers may be prescribed as necessary by your caregiver. Use only as directed

Heat and Cold

  • Cold is used to relieve pain and reduce inflammation. Cold 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 massage the area with a piece of ice (ice massage). Use a towel between the ice and your elbow to reduce the chance of injury to the ulnar nerve at the inner elbow

  • Heat may be used before performing stretching and strengthening activities prescribed by your caregiver. Use a heat pack or soak your injury in warm water

Seek Medical Care If

  • Symptoms get worse or do not improve in 4 to 6 weeks despite treatment
  • You experience pain, numbness, or coldness in the hand
  • Blue, gray, or dark color appears in the fingernails
  • New, unexplained symptoms develop (drugs used in treatment may produce side effects)