Ulnar collateral ligament injury of the elbow
Ulnar collateral ligament injury of the elbow | |
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Location of UCL injury | |
Specialty | Orthopedic |
Ulnar collateral ligament injuries can occur during certain activities such as overhead
Signs and symptoms
Pain along the inside of the elbow is the main symptom of this condition. Throwing athletes report it occurs most often during the acceleration phase of throwing. The injury is often associated with an experience of a sharp “pop” in the elbow, followed by pain during a single throw.[2] In addition, swelling and bruising of the elbow, loss of elbow range of motion, and a sudden decrease in throwing velocity are all common symptoms of a UCL injury. If the injury is less severe, pain can alleviate with complete rest.[3]
Causes
The UCL stabilizes the elbow from being abducted during a throwing motion. If intense or repeated bouts of valgus stress occur on the UCL, injury may occur. Damage to the UCL is common among baseball pitchers and javelin throwers because the throwing motion is similar. Physicians believe repetitive movements, especially pitching in baseball, cause UCL injuries. Furthermore, physicians have stated that if an adolescent throws over 85 throws for 8 months or more in a year, or throws when exhausted, the adolescent has a significantly higher risk of UCL injury.[4]
Injuries to the UCL may result from poor throwing mechanics, overuse, high throwing velocities, and throwing certain types of pitches, such as curveballs.[citation needed] Poor mechanics along with high repetition of these overhead movements can cause irritation, microtears or ruptures of the UCL. Kinetic chain dysfunction due to poor lower extremity strength, core strength and stability can be associated with UCL injuries, as well as capsular stiffness in glenohumeral internal rotation deficit (GIRD), and scapular dyskinesis.[9][10] Injuries to the UCL in baseball players are rarely due to one-time, traumatic events. Rather, they more often occur due to small chronic strains and tears accumulating over time.[citation needed]
Anatomy
The
Diagnosis
In most cases, a physician will diagnose an ulnar collateral ligament injury using a patient’s medical history and a physical examination that includes a
Classification
A slow and chronic deterioration of the ulnar collateral ligament can be due to repetitive stress acting on the ulna. At first, pain can be bearable and can worsen to an extent where it can terminate an athlete’s career. The repetitive stress placed on the ulna causes microtears in the ligament resulting in the loss of structural integrity over time.[15]
The acute rupture is less common compared to the slow deterioration injury. The acute rupture occurs in collisions when the elbow is in
Treatments
UCL injuries may or may not require surgery. Non-surgical treatment will primarily focus on strengthening the elbow joint to regain strength and stability.[18] First a course of
Surgical treatment may help restore the ability to perform the overhand throwing motions most commonly associated with UCL injuries. The reconstructive surgery, generally known as
The patient may begin
In a study conducted by Dr. Frederick Azar, 78 Tommy John surgeries were performed and analyzed after the surgeries. Of the 78 patients, 8 of them (8.8%) reported complications. Two patients had superficial infections that resolved with oral antibiotics, two patients reported tightness or tenderness at the surgery site, and one had a superficial wound infection at the elbow incision that resolved with oral antibiotics. One patient developed postoperative ulnar nerve damage. Two patients had damage to the posteromedial part of the olecranon and required reoperation.[24]
A 2015 study found that MLB pitchers who had Tommy John surgery returned to pitch in the MLB 83% of the time and only 3% failed to return to pitch in the MLB or the minor league.[20]
Beginning in 2007, there was an increase in the numbers of Tommy John surgeries. The increase was related to the false perception that the surgery improved the stability of the UCL joint. Many athletes believed this false perception, so they lied about their symptoms hoping to undergo the surgery. In order to combat the rumors, physicians were motivated to educate the public that Tommy John surgeries are only for those who have severe UCL injuries. The surgery will have an insignificant effect if the patient does not have a severe UCL injury.[25]
Epidemiology
According to the International Classification of Diseases, 9th Revision, Clinical Modification, ICD-9-CM, in 2008 the U.S. listed the diagnosis code for UCL injury as 841.1: Sprain ulnar collateral ligament. There were 336 discharges of UCL injuries. Within the total discharges, separated by age groups: 18- to 44-year-olds; 165 people (49.17%). 45- to 64-year-olds; 91 (27.08%). 65- to 84-year-olds, 65 (19.35%) it shows that the UCL injuries were more commonly found in men than women. There were 213 men compared to 123 women with UCL injury. Most of these injuries were also paid through private insurance (170: 50.63%) and Medicare (70: 20.85%).[26] The average estimated cost for the surgery was $21,563 in 2012.[27]
References
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- ^ Ulnar Collateral Ligament Injury at eMedicine
- ^ Anderson B (2010). "Ulnar collateral ligament sprain". Sports Injury Info.
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- ^ a b Edell D. "UCL Injuries". The Athletic Advisor. Archived from the original on 17 July 2010.
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- ^ PMID 16325092.
- ISBN 0-7216-1416-7.[page needed]
- ^ "Athletic Injury Examination Special/Stress Tests for the Elbow". The University of West Alabama.
- S2CID 25744733.
- S2CID 25478080.
- S2CID 46543114.
- PMID 10553236.
- ^ a b c "Patient Guide to UCL Injuries of the Elbow (Ulnar Collateral Ligament)". Johns Hopkins Sports Medicine. Archived from the original on 3 April 2012.
- ^ Ulnar Collateral Ligament Injury~treatment at eMedicine
- ^ a b Erickson, Brandon J. "The epidemic of Tommy John surgery: the role of the orthopedic surgeon." Am J Orthop (Belle Mead NJ) 44.1 (2015): E36-37.
- ISSN 2059-7754.
- ISBN 0-87322-897-9.[page needed]
- ^ PMID 27114930.
- S2CID 11494166.
- ^ Longman J (20 July 2007). "Fit young pitchers see elbow repair as cure-all". The New York Times.
- ^ U.S. Department of Health & Human Services: Agency for Healthcare Research and Quality - Advancing Excellence in Health Care. "HCUPnet: A tool for identifying, tracking, and analyzing national hospital statistics". Archived from the original on 2015-03-01. Retrieved 2015-03-01..
- ^ "Ulnar Collateral Ligament Reconstruction Surgery Cost". SurgeryCost.net. Archived from the original on 14 March 2012.