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Elbow Sprain and UCL Tear Treatments - Houston, Beaumont, Cypress TX

UCL Reconstruction (Tommy John Surgery)

The ulnar collateral ligament (UCL) is present on the inner side of the elbow and connects one of the forearm bones called the ulna to the upper arm bone called the humerus. It provides stability to the elbow, especially during overhead activities such as throwing. Forceful or repetitive throwing (especially overhead throwing), or a fall on an outstretched arm may damage the ulnar collateral ligament causing it to stretch or tear (sprain). It is one of the main stabilizing ligaments in the elbow especially with overhead activities such as throwing and pitching.

When this ligament is injured, it can end a professional athlete’s career unless surgery is performed. The stress of repeated throwing on the elbow causes microscopic tissue tears and inflammation. With continued repetition, eventually, the UCL can tear preventing the athlete from throwing with significant speed. UCL injury may also be caused by direct trauma such as with a fall, car accident, or work injury. Other causes include any activity that requires repetitive overhead motion of the arm such as tennis, pitching sports, fencing, and painting.

What are the symptoms of UCL Sprains?

Elbow sprains can lead to the following symptoms:

  • Pain on inner side of the elbow
  • Unstable elbow joint
  • Elbow tenderness
  • Swelling of the elbow
  • Limitation in movement.
  • Popping sound is often associated with UCL tears
  • Decreased performance in activities such as throwing baseballs or other objects
  • Reduced throwing velocity
  • Poor grip strength
  • Numbness in the ring & pink fingers

What are the types of UCL Sprains?

UCL Sprains are graded according to severity:

  • First Degree UCL Sprain: Cause pain to the ligament but no stretching or lengthening.
  • Second Degree UCL Sprain: Cause pain and stretching of the ligament.
  • Third Degree Sprain: Result from ligament tears, which significantly affect function.

How Do You Diagnose UCL Sprains?

UCL injury should be evaluated by an orthopedic specialist for proper diagnosis and treatment.

Your physician will perform the following:

  • Medical history
  • Physical examination including a valgus stress test to assess for elbow instability

Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis. An MRI and other imaging studies may be ordered to identify ligament tears or any other abnormalities.

How Do You Treat UCL Sprains?

First and second grade UCL sprains are treated by resting the elbow, ice application, medication and splinting. Third degree UCL sprains are first treated conservatively to reduce pain and swelling. This is followed by surgery to repair or reconstruct the ligament. Your doctor will recommend exercises or a rehabilitation program to stretch and strengthen the ligament, and restore maximum function. 

Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.

Conservative treatment options that are commonly recommended for non-athletes include:

  • Activity restrictions
  • Orthotics
  • Ice compression
  • Medications
  • Physical therapy
  • Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
  • Professional instruction

Majority of the cases gets better without surgery. If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, Dr. Gombera performs ulnar collateral ligament reconstruction surgery also called Tommy John surgery.

What is Tommy John Surgery (UCL Reconstruction)?

If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (auto graft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery includes the following:

  • The surgery is performed in an operating room under regional or general anesthesia
  • Your surgeon will make an incision over the medial epicondyle area
  • Care is taken to move muscles, tendons, and nerves out of the way
  • The donor tendon is harvested from either the forearm or below the knee
  • Your surgeon drills holes into the ulna and humerus bones
  • The donor tendon is then inserted through the drilled holes in a figure 8 pattern
  • The tendon is attached to the bone surfaces with special sutures
  • The incision is closed and covered with sterile dressings
  • Finally a splint is applied with the elbow flexed at 90 degrees.

What To Expect after Tommy John Surgery (UCL Reconstruction)

After surgery, your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common post-operative guidelines include:

  • Elevate your arm above heart level to reduce swelling
  • Wear an immobilizing splint or cast for 1-3 weeks
  • Apply ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
  • Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
  • Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
  • Eating a healthy diet and not smoking will promote healing

Risks and complications after Tommy John Surgery (UCL Reconstruction)

As with any major surgery, there are potential risks involved.

The majority of patients suffer from no complications following UCL Reconstruction surgery, however, complications can occur following elbow surgery and include:

  • Infection
  • Limited range of motion
  • Nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area
  • Cubital Tunnel Syndrome
  • Elbow instability

 

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