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Ulnar Collateral Ligament, UCL Tear – Unparalleled Knowhow

An ulnar collateral ligament or UCL injury is an elbow injury and a common sports injury. UCL tear or torn UCL can happen due to overuse. The ligament injury can cause pain and tenderness at the elbow. Treatments can include rest, icing, medications and physiotherapy.

Ulnar Collateral Ligament:

Ulnar Collateral Ligament, UCL Tear

The ligament is a strong band of tissue that hold the bones, humerus, and ulna together. The ligament helps to control the movement of joints. It is a tether between the bones, and torn UCL can make them move too much. The ligament is our elbow joint which keeps the joint stable during sports or arm movements. UCL tear during sports injury causes pain, instability and inability to use the elbow or hand efficiently. 

Elbow joint is a combination of a pivot and hinge joint. The pivot allows the lower arm to twist and rotate, and the hinge allows the arm to bend and straighten. The ligament is located medial side of the elbow, and it is attached on one side to the upper arm bone or humerus and on another side to the forearm bone or ulna. It consists of the anterior or front, posterior or back and transverse or across the bands, which are the three bands or divisions of the ulnar collateral ligament. The anterior band is essential for the elbow’s stability. 

Stress on the ligament may happen from repetitive overhead movement or a fall. It can cause irritation, inflammation, stretch, partial tear or complete UCL tear. Ligament damage causes pain, looseness of the elbow joint and loss of functionality.

Classification of UCL injury:

There are 3 grades of UCL injury:

Ulnar Collateral Ligament, UCL Tear
Ulnar Collateral Ligament, UCL Tear
  • Grade 1: The ligament is stretched, but there is no tear.
  • Grade 2: Partially torn UCL ligament.
  • Grade 3: Complete UCL tear.

Symptoms of a torn UCL injury:

Mild to moderate symptoms of UCL tear can include:

  • Tenderness
  • Pain
  • Weakness or instability of the elbow.
  • Weak hand grip.

Symptoms of a torn UCL ligament are:

  • A sudden pop inside of the elbow.
  • Severe pain due to UCL tear.
  • Numbness and tingling in the ring and pinky fingers.

Causes of a UCL tear

UCL tear is one of the most common sports injuries. Overuse and trauma are the primary injuries affecting the ligament.

Overuse:

Ulnar Collateral Ligament, UCL Tear
Ulnar Collateral Ligament, UCL Tear

In most cases, damage happens due to overuse of the ligament. Repetitive motion, such as overhand throwing, can cause stress. Continuous strenuous use causes the ligament to stretch and become irritated, and the tissue breaks down from small micro tears. The torn ligament may become inflamed and tear partially or entirely.

Traumatic injury:

A sudden hit or blow to the ligament can cause UCL injury. A fall with a landing on the outstretched arm can result in dislocation of the elbow or fracture, which can injure the ligament.

Diagnosis

The healthcare provider or doctor performs a physical exam after reviewing can medical history. Doctors can check the range of motion, elbow stability, strength and shoulder. They try to find the exact location of pain, and they can also ask for below tests mentioned. 

Ulnar Collateral Ligament, UCL Tear
Ulnar Collateral Ligament, UCL Tear
  • Valgus stress test for torn UCL. It is a physical test where the elbow is placed in 20° to 30° of flexion with the forearm supinated, and valgus stress is applied. The test is positive when no firm endpoint is palpated, greater than 1 mm of the medial joint opening is noted, or there is a reproduction of the patient’s pain.
  • Computed tomography (CT) and X-rays. CT and X-rays show pictures of the bones or stress fractures that contribute to pain and limited elbow motion. These tests don’t show soft tissue such as ligaments.
  • Magnetic resonance imaging (MRI) scan. MRI shows injuries to soft tissues such as tendons and ligaments. It can also show minor fractures that are not clear on X-rays.
  • Arthrogram. It is an MRI plus a dye injection to easily find hard-to-detect problems in the elbow joints.

Treatments

Treatments depend on the severity of the UCL injury. If one has a minor UCL tear, it may heal on its own, and one can find relief from pain and discomfort through nonsurgical treatments.

Nonsurgical treatments for UCL injury include:

  • Completely resting the injured hand. 
  • Use icing to reduce swelling and pain. 
  • Use of pain relief medicines as prescribed by the doctor.
  • Physical therapy could be used to strengthen the muscles around the elbow.
  • Injections of platelet-rich plasma treatment are used for partial UCL tears. In this treatment, a small amount of blood is withdrawn, and the platelets are separated. After that, the platelets are injected into the injured area. 

Surgical treatments for UCL injury include:

  • Direct repair. If the ligament is pulled off the bone due to a single traumatic event, it is possible to reattach it.
  • Reconstruction or Tommy John Surgery. Suppose nonsurgical treatments don’t provide relief or one as an athlete wants to continue strenuous overhead arm movements. In that case, the health care professional can advise reconstruction or Tommy John Surgery. A tendon (hamstring tendon, palmaris longus tendon from the forearm or big toe extensor tendon are generally used) is taken from another area of the or from a donor. The tendon is then attached to the ulna and humerus, which acts as the new ulnar collateral ligament. Surgery can restore the stability of the elbow and range of motion with improved elbow strength.

References

1. Ballestrini, C. (2017, August 2). Ulnar collateral ligament tears. Uconn.edu. https://health.uconn.edu/orthopedics-sports-medicine/conditions-and-treatments/where-does-it-hurt/elbow/ulnar-collateral-ligament-tears/

2. Lebovic, J. A., Dyer, G. S., & Khurana, B. (2019). Radiographic predictors of medial collateral ligament injury and stability of the elbow. JB & JS Open Access4(4), e0017. https://doi.org/10.2106/jbjs.oa.19.00017

3. Major, N. M., Anderson, M. W., Helms, C. A., Kaplan, P. A., & Dussault, R. (2020). Wrist and Hand. In Musculoskeletal MRI (pp. 263–294). Elsevier. Stahl, R. A., & Eckenrode, B. J. (2020). The nonoperative rehabilitation of a traumatic complete ligament tear-torn ucl-of the elbow in a high school wrestler: A case report. International Journal of Sports Physical Therapy15(6), 1211–1221. https://doi.org/10.26603/ijspt20201211

4. (ulnar collateral ligament) injury. (n.d.). Hospital for Special Surgery. Retrieved December 30, 2022, from https://www.hss.edu/condition-list_ucl-ulnar-collateral-ligament-injuries.asp

5. Ulnar collateral ligament injury. (2017). Stanfordhealthcare.org. https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/ulnar-collateral-ligament-injury.html

6. Wikipedia contributors. (2022, July 13). Torn UCL, Ulnar collateral ligament of elbow joint. Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/w/index.php?title=Ulnar_collateral_ligament_of_elbow_joint&oldid=1097864106

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