UCL Tears

1. Repetitive Overhead Motion: Overhead throwing motions, such as those seen in baseball pitchers, place significant stress on the elbow joint, particularly the UCL. Over time, this repetitive stress can lead to microtrauma and eventual UCL injury.
2. Acute Trauma: Direct impact or sudden hyperextension of the elbow joint, often seen in contact sports or accidents, can cause acute UCL tears.

1. Pain: Patients with UCL injuries often experience pain on the inner side of the elbow, particularly during throwing motions or activities that stress the ligament.
2. Instability: Instability or a feeling of “looseness” in the elbow joint may be present, particularly during the acceleration phase of throwing.
3. Decreased Performance: Athletes may notice a decline in throwing velocity, accuracy, or endurance due to pain and instability.

1. Physical Examination: A thorough physical examination, including assessment of elbow range of motion, stability testing, and provocative tests (such as the valgus stress test), is essential for diagnosing UCL injuries.
2. Imaging Studies: Imaging studies, such as MRI or ultrasound, may be ordered to visualize the integrity of the UCL, assess the extent of the injury, and rule out associated pathology such as osteochondral defects or loose bodies.

Conservative Management:

• Non-operative treatment may be considered for partial UCL tears or cases with minimal symptoms.
• Conservative measures may include rest, activity modification, physical therapy focusing on strengthening the forearm and shoulder musculature, and a gradual return to throwing activities under the guidance of a qualified rehabilitation specialist.

Tommy John Surgery (UCL Reconstruction):

• Surgical intervention, known as Tommy John surgery or UCL reconstruction, is often recommended for high-level athletes or patients with complete UCL tears and significant functional impairment.
• During UCL reconstruction, a graft (often harvested from the patient’s forearm or hamstring tendon or obtained from a donor) is used to reconstruct the damaged UCL, restoring elbow stability and function.
• Postoperative rehabilitation involves a structured program to protect the graft, restore elbow range of motion and strength, and gradually reintroduce throwing activities over several months.