Ulnar collateral ligament sprain is a mild injury to the ulnar collateral ligament (UCL), which attaches the ulna (forearm bone) to the distal end of the humerus. The UCL allows the arm to flex by pivoting at the elbow joint. Damage to the UCL typically causes pain along the inside of the elbow, which can sometimes cause these injuries to be mistaken for injuries to the nearby medial epicondyle. This is most common in overhead throwing athletes such as baseball pitchers.

  • Repetitive Strain Injuries (RSI) caused by overuse of the ulnar collateral ligament  in the elbow
  • Conditions that cause instability in a joint, like dislocations
  • Traumatic injuries, like avulsion fractures
  • Improper stretching mechanics that loosen the ulnar collateral ligament
  • Single-sport participation and year-round training in the younger population (particularly for baseball or softball pitchers)
  • UCL pain along the medial (inside) side of the elbow
  • Pain on palpation of the area.
  • Deformity along the medial epicondyle
  • Pain with throwing
  • Little league elbow pain along the medial side of the elbow
  • Pain and numbness that spreads down the forearm into the hand
  • A feeling of weakness in the arm, and elbow joint

Treatment for UCL sprain may require resting the joint to allow pain and inflammation to subside. Physical therapy interventions can help improve: range of motion, strength, coordination, proprioception and endurance. Formal therapy and compliance with an extensive home program is the mainstay to restoring function of the elbow.

Goals for physical therapy are optimal loading and restoration of normal tissue relationships to improve motion, strength, and ability to perform functional activities of daily living.

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation and restore normal joint mechanics and range of motion.
  • Therapeutic Exercises (TE) including exercises to improve strength and performance of the elbow and related muscles.
  • Neuromuscular Re-education (NMR) to restore stability, begin retraining the upper extremity, improve proximal joint stability and improve movement technique and mechanics (for example: throwing) in use of the involved upper extremity in daily activities especially overhead activities.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold and laser to decrease pain, improve mobility and reduce inflammation of the elbow joint and surrounding muscles and tendons.
  • Home program development should include strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

The use of pain medications, immobilization, rest and ice are the first line of treatment.

Prognosis

Rate of recovery and the prognosis from UCL sprain will depend on a number of factors:

  • Severity – UCL sprains do well with immobilization and physical therapy.
  • Age- Younger individuals recover faster and are less likely to have residual deficits. Younger individuals heal quicker, have better circulation, are stronger and usually their pre-injury tissue integrity is better.
  • Prior activity level plays an important role in post-injury recovery. Those who exercise regularly are stronger and more flexible, and generally have an easier and more complete recovery.
  • Compliance- Patients that are committed to their rehabilitation program and are compliant with their home program are more successful in returning to full function.
  • By nine months to a year most individuals can return to throwing and normal function.

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