Ulnar Collateral Ligament (UCL) Injuries: Treatment Options

Ulnar Collateral Ligament (UCL) Injuries: Treatment Options

This video will provide an overview of treatment options for injuries to the elbow's medial ulnar collateral ligament, or M U C L. To review the pertinent anatomy, the MUCL lies on the medial or inner side of the elbow and connects the humerus to the ulna.

Treatment for a sprained elbow depends on the severity of injury. Most of the time, these injuries heal without surgical intervention. The standard nonoperative first line of treatment typically focuses on rest and physical therapy. The R.I.C.E. Method may help, especially within the first few days of injury. This acronym stands for resting from throwing to prevent further damage, icing for 20 minutes every few hours, compression, and keeping the arm elevated above the heart to decrease swelling.

Physical therapy will focus on improving forearm muscle strength and improving the athlete's technique of throwing mechanics. A hinged brace can be prescribed if the injury is sudden or acute. If the injury is severe, surgery or operative treatment may be necessary. There are several surgical options, depending on the severity and chronicity of the injury. These include repair and reconstruction of the injured medial ulnar collateral ligament.

A repair is performed when the ligament injury is sudden and there is adequate ligamentous tissue available to be fixed. The latest technology uses an additional supporting suture on top of the repaired ligament to protect the ligament during the healing period. It is a thick suture that lays over the repair. It also allows for early motion and subsequent earlier return to throwing, especially in athletes.

Reconstruction of the ulnar collateral ligament, or the modified Jobe technique, is often performed on baseball pitchers. This is commonly known as Tommy John surgery, after the baseball pitcher who initially had the procedure in 1974. This procedure is done when there is no adequate ligamentous tissue left to be repaired. The surgeon takes a tendon, shown in blue from elsewhere in the body, to reconstruct the medial ulnar collateral ligament on the inside of the elbow.

A reconstruction requires the creation of bony tunnels to weave and secure the tendon graft. The shape of these tunnels resembles a figure of 8. There are several other modifications or configurations of reconstruction.

Regardless if the surgeon chooses nonoperative versus operative treatment for the elbow sprain injury, the goal remains the same to strengthen and stabilize the healing elbow to regain its full range of motion and potential.