ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel
  • »
  • Education and Science»
  • Medicine & Health Science

Understand Surgery: Repairing an Ulnar Collateral Ligament (UCL) Injury

Updated on March 18, 2015

What causes an Ulnar Collateral Ligament (UCL) injury?

A ligament is a tough, fibrous connective tissue that keeps bones attached to one another. Over time, repetitive overhead motion weakens the Ulnar Collateral Ligament (UCL), which may cause it to rupture. Unfortunately, this means that baseball players, tennis players, volleyball players, and other athletes are some of the most common victims of UCL injuries.

Extreme Valgus- Distorted Elbow

Source

Healthy Ulnar Collateral Ligament

The elbow is made up of three main bones: the humerus, the ulna, and the radial. The ulnar collateral ligament (UCL) spans the humerus and attaches to the ulna. The UCL makes up three separate bands: then anterior oblique ligament, posterior oblique
The elbow is made up of three main bones: the humerus, the ulna, and the radial. The ulnar collateral ligament (UCL) spans the humerus and attaches to the ulna. The UCL makes up three separate bands: then anterior oblique ligament, posterior oblique | Source

How a UCL Injury is diagnosed.

A UCL injury is typically caused when the abnormal displacement of a part of a limb away from the center of the body (extreme valgus) part is placed on the elbow.

In order to properly diagnose a UCL injury the doctor must first: evaluate the patient's history, conduct a physical exam, and order x-ray imaging. If the patient is nominated for surgical intervention he must undergo an arthrogram. This allows the medical team to measure the amount of damage caused to the ligament by determining whether or not there is a partial or complete tear in the UCL.

If the patient qualifies for surgical intervention his/her elbow is arthroscoped and evaluated for biological debris, spurring, synovitis, and chondral breakdown. A doctor will administer one final stress test over the ligament and once deficiency is confirmed reconstructive surgery can begin.

Acute Vs. Chronic UCL Injury

UCL Injury
Origin & Symptoms
Treatment
Acute
The patient hears and/or feels a loud "pop" and the ligament fails. Patients may have tingling and/or numbness in their fourth and fifth fingers. The patient is likely to feel excruciating pain on the medial aspect of the elbow.
Nonoperative treatment includes: rest, ice, anti-inflammatory medication, and physical therapy (typically lasting 3-6 months).
Chronic
The patient's ligament fails over a period of time. An athletic patient may notice a loss of velocity, pitching control, and fatigue.These patients may also feel dysesthesias (abnormal sensation) when they throw an object. Patients with chronic UCL injury may also have mild pain in the posteromedial aspect of the elbow. The majority of pain (if any) is typically felt directly above the UCL when direct pressure is applied.
Surgical intervention
*Platelet Rich Plasma Therapy , at times, can prove to be an excellent alternative to surgery.* Athletes that commonly throw in an over head motion (such as baseball players, javelin throwers, and tennis players) are the most common victims of UCL

Depiction of UCL Reconstruction

Surgical Procedure Summarized

Once the ligament deficiency is confirmed the surgeon may commence with the procedure. The surgeon makes his initial incision over the medial aspect of the elbow and along the course of the ulnar nerve. The surgeon takes the incision down through the skin and subcutaneous tissue. The muscle is split and the ulnar nerve is protected. The surgeon identifies the anatomical position of the UCL. The surgeon drills into the full length of the ulna using a 4.5-mm drill and then measures the length of the ulnar tunnel. The surgeon obtains a palmaris longus or gracilis graft from the patient by using a suspension technique. A k-wire is drilled across the length ulna to obtain the graft.The surgeon prepares the site by using a 7-mm reamer to drill 15-mm into the ulna. The graft is then placed in the loop of the suspension device. The ligament and suspension device are pulled through the 4.5-mm hole and into the 7-mm hole. While the suspension device passes through the 4.5mm hole it is flipped; this holds the ligament taut onto the cortex of the ulna. Once completed, the ligament is placed into the 7-mm hole via ZipLoop technology. Once the ligament is situated in the hole the surgeon puts tension on the graft; this allows him to properly adjust the graft for the correct anatomical the position of the medial epicondyle. The surgeon begins to close surgical site by drilling a 15-mm hole (using a 7-mm reamer) into the medial epicondyle and two small holes to accommodate the suture. Using an interrupted Ethibond suture, the surgeon brings the main component of the graft through the 7-mm hole and the two limbs with subsequent sutures are pulled into the small holes. The surgeon uses a Hewson suture retriever to tie the two limbs over the bone bridge in the medial epicondyle.


Postoperative Care

After the surgery is completed the patient will be placed in a bulky dressing and a posterior splint. On either the fourth or fifth day the patient returns to the office and is given a light elbow brace locked at 90 degrees, and on day five the patient begins physical therapy. Physical therapy initially includes limited full extension and flexion, but is gradually increased to a wider range of motion over the next four to six weeks.

Once the patient's full range of motion and strength have returned physical therapy culminates into an interval throwing program to strengthen the posterior shoulder, medial elbow, and core.

It is particularly important for athletic patients to pay extra attention to their ipsilateral shoulder.

Source

Prognosis and Complications

Athletic patients are often allowed to return to sports between 6-12 months after their surgery, depending on their position within the sport. Functional results typically range from 85%-90% in comparison to the patient's pre-injury status.

Complications may include ulnar nerve symptoms, a graft that is either too tight or too loose, postoperative infections, and sensory nerve paresthesias.

References

1. Lehman, Richard, MD. "Ulnar Collateral Ligament Reconstruction." The Surgical Technologist. Pages 401-407, September 2013.

2.Kacprowicz, Robert, MD. "http://emedicine.medscape.com/article/97451-treatment"

Comments

    0 of 8192 characters used
    Post Comment

    • AVailuu profile image
      Author

      A. Cristen Vailuu 3 years ago from Augusta, Ga

      Thank you for the review! Unfortunately I'm more of a medical geek, and not very knowledgeable of athletes!

    • lions44 profile image

      CJ Kelly 3 years ago from Auburn, WA

      This was an incredibly detailed article. Explalined a lot. Is this the same as Tommy John surgery? I'll have to look that up. Now every time I hear the term "ulnar collateral ligament" during the season, I will know what they are talking about. Voted up and shared.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: "https://hubpages.com/privacy-policy#gdpr"

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)