SCINQ Guide to Baseball Injuries: Ulnar Collateral Ligament

If there’s one injury that transcends the sport of baseball, it’s damage to the ulnar collateral ligament. The corrective procedure for the condition was pioneered by Dr. Frank Jobe and performed on then Los Angeles Dodgers pitcher Tommy John. Subsequent operations came to be known popularly as Tommy John surgery.

Condition: The UCL is a ligament on the inner side of your elbow that helps secure your elbow joint. Specifically, it’s the ulnar collateral ligament that runs from the end of the humerus, aka the arm bone, and attaches to the ulna, aka the inner forearm. It reinforces the elbow joint. Damage to the UCL normally cause pitchers to experience a considerable lack of throwing control as well as pain on top of the ligament.

Symptoms: Pain in inside of elbow, especially when throwing or overhead motions. Numbness or tingling in arm or fingers. Elbow instability.

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Diagnosis: Diagnosis of a UCL injury is usually performed by an orthopaedic specialist, physical therapist or sports medicine physician. Evaluation by examination of elbow, supplemented with a review of patient’s medical history. Imaging tests, such as an MRI or X-ray, may be performed in order to confirm where the damage is located. 

Treatment: Normally, pitchers opt for two cycles of rest and rehab prior deciding whether to going under the knife.

Tommy John Surgery, or ulnar collateral ligament restoration, typically consists of replacing the damaged UCL with ligament from another part of the body (called a graft). The ultimate goal is the stabilization of the elbow, reduction or complete eliminate of pain and restoration of stability and range of motion.

Grafts are usually taken from one of three places: the palmaris longus tendon from the forearm, hamstring tendon, big toe extensor tendon. Once the incision is made and muscles and tissue moved out of the way, the surgeon assesses the tear. Damaged tissue is removed, although in certain occasions the surgeon will attach the remnants of the original ligament to the graft in order to reinforce the structure. After holes are made in the elbow, the graft is then weaved in and out of the holes.

Rehab: Recovery from Tommy John Surgery tends to be a two year process. Because of the expected length of recovery time, pitchers often opt to correct other minor ailments at the same time, say a minor shoulder injury. The lengthy rehabilitation duration allows pitchers to strengthen the rest of their bodies, allowing them to return to the mound stranger than before their injury. Naturally, this alleviates strain on the pitching arm because the entire body is supplementing the demand put on the throwing arm.

Once the pitcher manages to return to the mound, it’s normal for strength to return first, while control and command take longer.

Players: Tommy John, Shohei Ohtani, Francisco Liriano, Adam Ottavino

IMAGE SOURCE: Creative Commons

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