What is an Ulnar Collateral Ligament?

Ulnar collateral injuries of the elbow are becoming more common and are occurring in younger athletes due to the high demand of their sports. The ulnar collateral consists of three bands (also called the medial collateral ligament) and supports the medial elbow. The anterior band is generally the largest and most at risk for injury. Athletes who participate in sports with overhead or throwing motions, such as baseball, football, javelin, tennis and racquetball, are at the highest risk of injury.

Most injuries occur slowly over time as the chronic stress of the throwing motion creates damage within the ligament. This damage can increase over time as the elbow is used in the same motion. This can lead to weakening of the ligament before it suddenly tears. Acute, complete tears of the ligament can also occur in previously injured ligaments or those with sudden force on the elbow, such as with a fall. This injury became more well known after professional baseball pitcher Tommy John was one of the first players in any sport to have surgery for this condition and successfully return to full competition.

How Do I Know If My Child has an Ulnar Collateral Ligament Injury of the Elbow?

Common signs and symptoms of injury include:

• Elbow pain with throwing and/or immediately after throwing
• Catching, popping, shifting of the elbow
• Decreased elbow range of motion
• Loss of speed and control with throwing

How is an Ulnar Collateral Ligament Injury of the Elbow Diagnosed?

Your child will complete a physical exam including a detailed elbow exam. The diagnosis is generally made by history and physical exam. Depending on the duration and severity of symptoms, your child’s doctor may order elbow X-rays to evaluate growth plates and, underlying bone structure, and to look for other causes of bone pain. Complete tears often require surgery to restore elbow strength and stability and are usually diagnosed by magnetic resonance imaging (MRI).

How is an Ulnar Collateral Ligament Injury of the Elbow Treated?

Once the diagnosis of ulnar collateral ligament injury is made, your child’s doctor will determine the best possible treatment plan.

Conservative management

• Rest – Your child’s doctor may recommend a period of time to avoid all stress to the elbow to allow for healing. The goal is to become completely pain free.
• Ice – This treatment helps to decrease swelling, inflammation and pain, allowing it to heal.
• Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and swelling. Dosage and potential side -effects will be discussed during your child’s appointment.
• Activity modification – Changes to your child’s usual physical activity specific to their sport involvement may be recommended. This includes complete rest from throwing, overhead lifting, and any activity that worsens pain.
• Physical therapy – Your child may work on range of motion and gentle strengthening exercises on their own or with a physical therapist. Once your child is pain free on an exam, they may start a more aggressive therapy regimen that includes a return to throw program and evaluation of their biomechanics. Your child’s therapist will work with them to design a specific regimen to restore strength, normal mechanics and function.

Conservative management often requires two-three months or more of treatment to return to full activity.

Immobilization and bracing

Depending on the severity of your child’s injury, their doctor may recommend one of the following:

• Sling – may be used temporarily in severe cases for pain control.
• Elbow wrap – may be used for swelling and pain control.
• Elbow brace – may be used for swelling, pain control, and protection for high-risk sports.

Surgery

Surgery may be indicated in cases where there is a complete tear of the ulnar collateral ligament, or, more severe injuries, such as those that also involve the ulnar nerve. Surgery may be needed in cases with a high degree of injury and persistent pain or instability despite non-surgical treatment. In these cases, your sports medicine doctor will refer you to a pediatric orthopaedic surgeon at Cincinnati Children’s to discuss surgical options and make the best decision for your child according to their long-term physical activity goals.

Surgical management often requires 9-12 months of treatment before the athlete is able to fully return to their sport.

Preventing Ulnar Collateral Ligament Injuries

Prevention is key to having a long and successful sports career. Ulnar collateral ligament injuries can be severe and lead to significant lost time from play. Being proactive will increase your chances of avoiding these injuries. To avoid these injuries:

1. Do not play through pain. If your child is having elbow pain, get this evaluated. This may lead to faster healing or avoidance of injury.
2. Do not play the same sport year round. Athletes who play year-round sports (more than 10 months per year) more than double their chance of overuse injuries. Participating in a variety of sports uses different muscle groups and will make your child a well-rounded athlete.
3. Do not play on more than one team or sport during a season. As the demands of youth sports continue to grow, time is needed for young athletes to recover. Playing multiple sports within a season increases the risk of injury by three times!
4. Be cautious of the frequency and number of pitches thrown. Age-specific pitch counts and recommended rest intervals are available to help guide you. Other throwing activities create similar stress in practice, and need to be taken into account. Multiple games in short time intervals can also lead to fatigue and distortion of your child’s mechanics.
5. Have your child’s mechanics evaluated. Poor biomechanics, such as side arm throws and poor core and shoulder strength, cause more stress on the elbow. This can lead to further injury.
6. Ensure your child is properly warming up, cooling down and resting between competition. Adequate rest is needed for the body to recover between training sessions. This may mean reducing the number of practices or games your child participates in.