Ulnar collateral ligament sprain is an injury to the ulnar collateral ligament (UCL), which attaches the ulna (forearm bone) on the “pinky” side to the distal end of the humerus. The UCL is a system of three fibrous tissue bands on the inside of the elbow and plays a critical role in stabilizing the elbow and allows the arm to flex by pivoting at the 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 injury is most common in overhead throwing athletes, such as baseball pitchers, javelin throwers and ultimate Frisbee athletes. In fact, recent studies demonstrate that injuries to the UCL in the elbow are on the rise, particularly among teenage baseball athletes ages 15-19 years old.
Throwing athletes are at high risk for ulnar collateral ligament injuries. They can also be caused by:
- Repetitive Strain Injuries (RSI) caused by overuse of the ulnar collateral ligament from a work activity or sport that places stress on the inner elbow
- Conditions that cause instability in a joint, like dislocations
- Traumatic injuries, like avulsion fractures
- Sudden activities that twist the ligament, such a falling onto the elbow or on an outstretched arm
- 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)
Symptoms of a UCL sprain include pain on the inside of the elbow, particularly when throwing or accelerating the arm forward, and a numbness sensation in the “pinky” and ring fingers.
- UCL pain along the medial (inside) side of the elbow
- Pain on palpation of the area.
- Deformity along the medial epicondyle
- Pain with throwing
- Swelling
- 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
- Decreased performance, such as slower pitching speed
Treatment for UCL sprain is initially conservative and may include resting the joint to allow pain and inflammation to subside. Physical therapy interventions following a UCL injury will focus on regaining active range of motion of the elbow and can help improve strength, coordination, proprioception, and endurance.
Formal therapy and compliance with an extensive home program is the mainstay to restoring function of the elbow.
The ideal solution is to prevent UCL injuries in the first place. Studies show that such preventative measures can reduce the incidence of UCL elbow injury by as much as 50 percent. Here are tips for athletes, coaches, trainers, and parents of young athletes:
- Offer regular strength and stretching programs.
- Provide continuing education for the coaching staff on proper preparation of athletes and how to reduce overhead stressors on the elbow and shoulder joints.
- Teach athletes how to move with proper body mechanics.
- Follow safety measures, such as reducing participation when fatigued. Research indicates fatigue plays a major role in UCL injuries.
- Cross-train athletes so they are exposed to different stimuli rather than placing the same type of mechanical stress on joints year-round.
- Get an pre-hab evaluation by a Physical Therapist experienced in elbow conditions.
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. Your physical therapist will conduct a thorough evaluation that includes taking your health and activity history to determine appropriate physical therapy interventions.
- 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.
- Plyometric drills can be performed during the later stages of recovery to train the elbow and shoulder to withstand high levels of stress.
- Return to activity, the final phase of UCL rehabilitation, allows the individual to progressively return to full function safely and progressively.
UCL sprains can be treated conservatively or surgically. The use of pain medications, immobilization, ice and rest are the first line of treatment to reduce pain and swelling. Physical Therapy is an effective treatment option for many UCL injuries because it helps to strengthen the surrounding muscles and decrease the chance to further the injury. A trusted Physical Therapist can also evaluate mechanics to determine if any changes need to be made to to reduce future stress placed on the elbow.
In some cases, if there is a complete tear of the ligament, surgical intervention may be considered.
Prognosis
There are three grades of sprain: grade 1, 2 and 3. A grade 1 sprain refers to a ligament that has been stretched, but no tear is felt. A grade 2 sprain refers to a ligament that has been stretched and a partial tear could be present. A grade 3 sprain indicates a complete tear of the ligament is present.
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.
