ULNAR COLLATERAL LIGAMENT OF THE ELBOW

Jacob Kotlicky

Program Coordinator

Return to Sport – Memorial Hospital West

Articulations and Motions

Humeroulnar- Flexion & Extension Humeroradial – Flexion/Extension,

Pronation/Supination Proximal Radioulnar –

Pronation/Supination

Total ROM’s: Flex/Ext = 145˚-155˚Pro/Sup = 170˚-180˚

Ligamentous Support

Ulnar Collateral Ligament - Primary medial stabilizer

Lateral Ulnar Collateral Ligament – Primary lateral stabilizer

Radial Collateral Ligament – supports against varus force, maintains humeroradial articulation

Annular Ligament – permits external/internal rotation of radius & ulna

UCL Breakdown

3 directional bundles Anterior: Taut throughout full ROM,

primary against valgus force Posterior: Taught in flexion past 60˚ Transverse: Minimal support to medial

elbow

Anatomy of the Elbow

Injury History/Observations

20 y/o baseball pitcher junior classman w/ 0 spring innings played

to date on collegiate level Right hand dominant No previous history of elbow injury While throwing a curveball felt a “pop” and

instant pain. Threw two more pitches and felt his arm

was “detached” as pain increased Swelling over the medial aspect of R elbow

Palpations/Special Tests

No paresthesia, tinel’s sign, - fractures Tenderness at UCL and medial epicondyle. Pain with valgus stress w/ minimal gapping AROM, PROM, RROM all WNL Dermatomes/myotomes intact Suspected UCL sprain. Athlete prescribed naprosyn and went for

immediate MRI

MRI Findings

UCL derangement of advanced stage and degree

“High-grade insertional partial tear involving the UCL insertion into the sublime tubercle”

“Thinning and attenuation of the distal inserting fibers”

Prominent edema in flexor pronator musculature

Chondromalacia and synovial thickening about the region.

UCL Reconstruction “Tommy John Surgery”

High rate of return to play Tendon harvested. Typically palmaris

longus. Hamstring tendon for this athlete

Tendon prepared – looped through holes drilled in radius and ulna at ligamentous attachment sites

Looped into a figure 8 and then sutured together.

Rehabilitation Process

Athlete immediately placed in a functional hinge brace

Extension initially limited to 60˚ Total amount of time braced will be 5-6

weeks In-clinic 2 x week supplemented by HEP

on daily basis 4 way SLR, heel drags and HS stretches Shoulder isometrics

Rehabilitation Cont.

Began passive stretching of biceps on 11/17/08 – Athlete is hesitant with tightness and pain due to held flexion for nearly two weeks.

Return to Play Criteria

FULL ROM Strength must be equal to that of other

arm No c/o pain in elbow w/ activity Completion of shoulder program Medical clearance from Dr. K.

References

Koh, JL, Schafer, MF, Keuter, G, & Hsu, JE. Ulnar collateral ligament reconstruction in

elite throwing athletes. Arthroscopy. 22 (11): 1187-1191

 Safran, MR. Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med. 23 (4): 643-663

Chen FS, Rokito AS, & Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. 9 (2): 99-113

Cain EL, & Dugas JR. History and examination of the thrower’s elbow. Clin Sports Med. 23 (3) 553-566

Limpisvasti O, ElAttrache NS, Jobe FW. Understanding shoulder and elbow injuries in baseball. J Am Acad Orthop Surg. 15 (3): 139-147

Hyman, J, Breazeale, NM, & Altchek, DW. Arthroscopic surgery for athletic elbow and wrist surgeries. Clin Sports Med. 20 (1): 5-21

Altcheck D, Hyman JL, Williams RJ. Ulnar collateral ligament reconstruction in throwers using the “docking” technique: two-year results. Sun Valley, ID, American Orthopaedic Association, 1999

Starkey C, Ryan J. Evaluation of Orthopedic and Athletic Injuries. 2nd ed. Philadelphia, Pa: FA Davis Company; 2002

QUESTIONS???