Ulnar Collateral Ligament (UCL) -Tommy John Surgery

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Anatomy/Purpose of the UCL:

The ulnar collateral ligament (UCL) is composed of 3 bundles and is the primary stabilizer of the elbow joint by resisting valgus or lateral forces.

UCL Injuries:

UCL injuries commonly occur from repetitive stress on the elbow, typically from pitching or other overhead throwing sports. The UCL can also be torn in an acute traumatic event such as a car accident or a football injury.

The stress placed on the UCL during every pitch in baseball is nearly the total amount of            force the UCL can withstand.

Signs and Symptoms:

  • Medial (inside) elbow pain
  • Hear or feel a “pop”
  • Clumsiness and weakness of the hand following injury
  • Numbness and tingling of the ring finger, little finger, and hand
  • A feeling of giving way, especially with throwing
  • Inability to throw as hard

Surgical Repair:

The first successful UCL repair was completed by Dr. Frank Jobe on LA Dodgers pitcher Tommy John in 1974, he returned to baseball in 1976.

The Tommy John surgery repairs the Anterior Band of the UCL.

To reconstruct the ligament the repair can be completed with either an autograph (tissue from the patient’s body) or an allograph (tissue from a donor). The most commonly used tendons are palmaris longus tendon or hamstring tendon.

Rehabilitation:

Initially patients may need to be in a hinge brace for about 4 weeks while appropriately progressing elbow range of motion, depending on specific surgeon’s protocols. Then strengthening will begin as early as 4 weeks and progress to return to function.

Zamst Brace:

The elbow sleeve may be appropriate for some patients while returning to sport post-UCL surgery. Consult with your physician to see if this brace is appropriate for you.

 

Written by Jennifer Branson, SPT. University of Southern California Doctor of Physical Therapy Program

 

References:

Erickson, Harris, et al. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Sports Health. 2015;7(6):511-517.

Purcell DB, Matava MJ, Wright RW. Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res. 2007; 455:72-77.

Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30(1):136-151.

University of Sports Medicine Wisconsin. Rehabilitation Guidelines for Elbow Ulnar Collateral Ligament (UCL) Reconstruction. Available at: http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM_UCL_reconstruction.pdf. Accessed on November 29, 2015.

Image from: http://fit-screen.com/tag/ulnar-collateral-ligament/. Accessed on November 29 2015.

 

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