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Ulnar Collateral Ligament Injury Treatment & Management

  • Author: Robert F Kacprowicz, MD, FAAEM; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Apr 14, 2016
 

Acute Phase

Rehabilitation Program

Physical Therapy

Generally, 3-6 months of conservative therapy with rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and local physical therapy for ROM are necessary for recovery.

Recreational Therapy

When pain and swelling completely resolve and the athlete has returned to a premorbid ROM (usually not before 3 months of treatment), progressive return to activity with increasing velocity and duration of training may be attempted.

Medical Issues/Complications

Surgery may be considered in several situations. Surgical repair is generally indicated for acute tears in competitive athletes, when chronic instability exists, and when the patient has recurring pain and laxity after 2 or more attempts at conservative therapy.

Surgical Intervention

Direct repair of the ligament is generally not indicated. Reconstruction of the UCL (eg, repair of the anterior bundle) is the more common approach to surgical treatment, with use of a palmaris longus tendon autograft. The graft is pulled through bone tunnels in the medial epicondyle of the humerus and the sublime tubercle of the ulna in a figure-8 pattern. Ulnar nerve transposition may be undertaken at the time of surgery, if indicated.

Consultations

Consultation with an orthopedic surgeon, preferably a sports or upper-extremity specialist, is indicated when surgical intervention is contemplated.

Other Treatment

Steroid injection is not recommended for UCL injuries.

Platelet-rich plasma has shown promise in a case series of throwing athletes with partial UCL tears who had failed conservative treatment. Of these athletes, 88% were able to return to throwing activities an average of 12 weeks after a single injection of platelet-rich plasma.[13]

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Recovery Phase

Rehabilitation Program

Physical Therapy

After surgery, the elbow is immobilized in a posterior splint for 10 days in 90° of flexion. The wrist is maintained free, and a soft rubber ball is given to the patient for squeezing to maintain grip strength. Active ROM is initiated after removal of the posterior splint. A hinged brace that prevents valgus stress should be used.

At approximately 1 month after surgery, isometric strengthening exercises should be initiated. Limited progressive strengthening can be initiated at 8 weeks and plyometrics at 12 weeks. Shoulder and elbow exercises should be instituted as soon as feasible, but valgus stress of the elbow should be avoided for at least 4-6 months until the graft has had sufficient time to incorporate.

Recreational Therapy

After 4-6 months, throwing may be resumed with a training program that is designed to return the patient to competitive throwing by 9-12 months after surgery.

Medical Issues/Complications

Both transient and permanent ulnar neuropathy may occur after reconstruction, occasionally requiring ulnar nerve transposition or revision of transposition. Flexion contracture (generally < 5°) may also occur in 25-30% of patients.

Surgical Intervention

Ulnar nerve transposition (or revision of transposition) may be required for persistent postoperative ulnar neuropathy.

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Maintenance Phase

Rehabilitation Program

Physical Therapy

Flexibility and strength training of the elbow are useful in the maintenance phase to prevent recurrent injury.

Recreational Therapy

During the maintenance phase, particular attention to the patient's throwing technique is essential to prevent recurrence of injury.

Medical Issues/Complications

Long-term complications may include chronic pain with throwing and chronic instability of the elbow.

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Contributor Information and Disclosures
Author

Robert F Kacprowicz, MD, FAAEM Private Practice

Robert F Kacprowicz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Eric Chumbley, MD Consulting Staff, Department of Sports Medicine, Trover Clinic

Eric Chumbley, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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