Majority of Athletes Return to Sport After Surgery on Ulnar Collateral Ligament

Athletes who put a tremendous amount of pressure on the elbow in a throwing movement, such as baseball and softball pitchers, javelin throwers, tennis players, and wrestlers, are at risk of an injury of the ulnar collateral ligament, a ligament in the elbow. This type of injury can be career ending but in the early 1970s, a surgeon, Dr. Frank Jobe, saved the career of baseball pitcher Tommy John, by reconstructing the damaged ligament. The surgery has been called Tommy John surgery ever since. Over the years it been adapted and improved to help many more athletes regain use of their elbow.

There three sections to the ulnar ligament, the posterior bundle, the anterior bundle, and the transverse bundle (the front, the back and across). When a pitcher throws the ball, there is an intense force placed on the ligament each time. As well as the stress on the ligament, there is also a great stress on the joint itself, which is caused valgus extension overload syndrome.

In order to diagnose the ligament injury, the surgeon needs to review the patient's history, when the pain started, when it happens the most, and whether the pain is only when throwing or if it occurs during other activities too. The typical complaint with ulnar ligament damage is complaints of pain when the arm is cocked, ready to throw, and as the arm picks up speed before throwing the ball. Patients can also complain of numbness in the hand and fingers or radiating pain down the forearm.

Testing can include palpating, pressing, over the ligament with the elbow bent between 50 and 70 degrees. If this causes pain or is tender, this is a sign of ligament damage. To surgeon also tests for elbow stability. X-rays are also important to see if there are any abnormalities in the bone. A stress x-ray should be done as well but of both x-rays so the surgeon can compare the two.

To treat this type of injury, if the tear is only partial, the usual treatment is resting the elbow from the stressful activity, usually between two and six weeks. Ice is used to help reduce inflammation as are anti-inflammatory medications. The patient shouldn't use a throwing motion at all during this healing period. If the patient is pain-free after the rest, he or she can begin throwing again provided the strength and range of motion are there. Sometimes, complete ligament tears are treated without surgery too, but this is only for patients who will not return to the previous sport or activity that will place the stress on the elbow.

If surgery is needed after rest and nonsurgical treatment don't eliminate the pain, it used to be that surgeons just repaired the ligament. However, this wasn't very effective and surgeons began reconstructing the ligament using grafts. This was a much more successful approach and allowed many (over 80 percent) athletes to return to their sport.

There is a newer surgical treatment that is being tested. It involves a docking technique with a screwed down graft. This technique seems to provide a more natural rebuilding of the ligament and has been showing some good results in clinical trials.

Research is continuing in an attempt to prevent these injuries in the first place. One finding is that if children don't throw curveballs, they limit their risk of injuring the elbow. As well, in many children's baseball leagues, the pitchers are only allowed to pitch a maximum number of pitches and must not pitch a certain number of games within a specific time period.

The authors of this article have found that an athlete who pitches or forces his or her elbow to perform sudden and forceful movements is at high risk for a ligament injury, but surgery for rebuilding the ligament has seen good results with over 80 percent of athletes returning to their level of play or even higher.

References: Carter Mitchell, E. Lyle Cain, and James R. Andrews. Ulnar collateral ligament injuries of the elbow. In Current Orthopaedic Practice . November 2008. Vol. 19. No. 6. Pp. 596-601.