This is the third and final installment in a series on injuries in the young thrower’s elbow. In the first two installments, (Part I, Part 2) we explained how the elbow works and discussed some common diagnoses in a young thrower’s elbow: Little Leaguer’s Elbow, avulsion fracture of the medial epicondyle, Osteochondritis dissecans (OCD) and Olecranon apophysitis.
In this article, we will discuss ulnar collateral ligament (UCL) injuries. There is a misperception that a UCL injury is caused by a single forceful throw. Read on to learn about how the UCL is at risk of overuse injuries and the signs and symptoms that are present long before a tear that leads to surgery.
Ulnar collateral ligament (UCL) injuries are more commonly seen in the older adolescent but may occur in the younger athletes as well. Elbow stability is crucial for a throwing athlete. The UCL is the most important stabilizer for the inside of the elbow. With repetitive throwing, the UCL becomes stretched and has small tears. This is painful and ultimately leads to instability in the elbow. These injuries rarely occur with a single event or throw. When asked, athletes who believe they injured their elbow in a single event will acknowledge a history of elbow pain with throwing.
Typically, the pain is on the inside of the elbow a just below the bony bump where medial epicondyle apophysitis can occur. Because the injury is to the soft tissue, X-rays are often normal. To better evaluate this problem and determine the best course of treatment, an MRI with contrast injected in the joint is used.
• Pain over the inside of the elbow with throwing • Gradually increasing pain • May feel unstable or “give way” • Rarely popping
With proper rest, an early injury to the UCL can heal. Rest and removal of the repetitive stress may allow early changes of stress in the ligament to resolve. Unfortunately, there is a perception that a period of rest can be detrimental to the career of the young athlete. The reality is that continuing to throw can result in major complications and may ultimately lead to a complete injury of the ligament, for which surgery may be the only option. This requires significant recovery and rehabilitation time out of sport and does not guarantee return to play. Early prevention of over-stress is the best way to avoid this negative effect on the performance and the psychological well-being of the young athlete.
The well-known surgical reconstruction of the UCL is named after Tommy John. He was a baseball player who successfully returned to major league pitching after having this procedure. While some more mature athletes return to play after this procedure, a large number do not and surgery at an early age is felt to be problematic for a long throwing career. There is no arguing that preventing the injury is ideal.
• Rest for at least 6-12 weeks • Immobilization with a hinged elbow brace may be recommended to improve compliance with rest • Anti-inflammatory medication may be needed • Therapy to focus on flexibility, strength, trunk and scapular stabilization • Surgery is typically needed for complete tears, or if the elbow is unstable • Focused training to improve throwing form is needed
Elbow Injury Prevention in Young Athletes
Throwing elbow injuries in our youth are PREVENTABLE. Parents and coaches are advocates for their young athletes. We’ve covered many tips in previous installments, but here are the top tips for avoiding a UCL injury.
Top Tips to avoid throwing related injuries:
• Recognize and respond early to signs and symptoms of an overuse injury • Stop pitching when the arm becomes tired or form becomes worse • Never pitch with pain • Training should focus on form, not quantity of throws
Philip L. Wilson, M.D., is a board certified orthopedic surgeon fellowship-trained in pediatric orthopedics and sports medicine. He is Assistant Chief of Staff at Texas Scottish Rite Hospital for Children and he leads the Sports Medicine Center. Dr. Wilson holds an appointment as Associate Professor of Orthopaedics and Pediatrics at the University of Texas Southwestern Medical School. He sees patients for sports injuries including bone, muscle, and ligament injuries on our North Campus, now in Plano.