The elbow joint is supported and stabilised by two major ligaments – the medial, or medial ulnar, collateral ligament which is located on the inside of the elbow and joins the ulna (one of the two lower arm bones) to the humerus (upper arm bone); and the lateral, collateral ligament which is located on the outside of the elbow and also joins the humerus to the ulna. Confusingly, one of the parts of the lateral collateral ligament is also called the ulnar collateral ligament, but tends to be known as the lateral ulnar collateral ligament to help differentiate. Combined with the naturally conforming shape of the elbow bones, these ligaments give stability to the elbow. The medial ulnar collateral ligament especially keeps the elbow stable during overhead arm movements and throwing. In this article, we will explore ulnar collateral ligament injuries, their diagnosis and treatment.
About your elbow joint
Your elbow combines a hinge and pivot joint – the hinge enables you to bend and straighten your arm while the pivot means you can twist and rotate your lower arm. Your (medial) ulnar collateral ligament (UCL) consists of three bands of tissue – the anterior, posterior and transverse bands. The anterior band plays a critical role in keeping your elbow stable.
Causes of medial ulnar collateral ligament (UCL) injuries
Making repetitive overhead arm movements or falling onto an outstretched arm can cause UCL injuries. The ligaments may become inflamed, stretched, or partially/ completely torn away from the bone, resulting in pain, instability and loss of function within the elbow joint. There are different grades of UCL injury – see below – and each will require a different type of treatment.
If you are involved in sports that require repetitive overhead throwing, such as baseball pitching or javelin throwing, you are most at risk of UCL injuries. This type of injury is often the result of overuse, so a job or sport that involves movements that strain your ulnar collateral ligament can result in microtears and inflammation which may lead to instability in the elbow joint. Over time, the ligament may tear.
You may also develop a UCL injury as the result of a fall or heavy blow to your elbow. Falling onto an outstretched arm is a typical cause of this type of injury. An elbow dislocation or fracture can be accompanied by a UCL injury.
Classifying ulnar collateral ligament (UCL) injuries
UCL injuries are graded according to the severity of the sprain:
- Grade 1 injuries mean the ligament is stretched but not torn.
- Grade 2 injuries involve stretching and potentially some tearing.
- Grade 3 injuries are when the ligament is completely torn.
Symptoms of ulnar collateral ligament (UCL) injuries
Symptoms vary according to how badly you have injured your ulnar collateral ligament. With mild injuries you may experience:
- Pain and tenderness on the inside of your elbow which is worse after using your arm to make overhead movements or after throwing.
- A feeling of instability or weakness in your elbow or a weak hand grip.
- Loss of function – you might notice that you can’t throw as fast or as hard as you did before.
With a torn ligament you may experience:
- A popping sensation along the inside of your elbow.
- Severe pain and loss of function.
- Tingling or numbness in your little finger and ring fingers.
A UCL injury normally makes it impossible to make strenuous or repetitive overhead arm movements although you may still be able to use your elbow for everyday activities.
Diagnosing ulnar collateral ligament (UCL) injuries
You will require a physical examination to diagnose a UCL injury. The doctor may ask you to move your arm in a particular way while pressing gently on the elbow joint to assess for instability and pain. You may need a CT scan, X-ray or MRI scan to check for stress fractures and damage to the ligaments and tendons around the joint.
Treating ulnar collateral ligament (UCL) injuries
For mild UCL injuries where there is stretching or a small tear, the ligament may heal on its own with sufficient rest. You can use painkillers and anti-inflammatories as well as ice packs to relieve pain and swelling. Physiotherapy exercises can help to strengthen the muscles around your elbow joint.
For more severe injuries you may require surgery. If the injury was caused by trauma (a fall or heavy blow to the elbow, for example) that has pulled the ligament away from the bone, you may be able to have surgery to reattach it. This is called a UCL repair.
UCL reconstruction surgery may be offered to athletes who need to be able to continue making strenuous overhead arm movements. This entails using a tendon from another area of your body or donor, which is attached to the ulna and humerus, forming a new ulnar collateral ligament. Recovery from UCL reconstruction surgery can take up to a year. You will need to wear a hinged brace to slowly increase your range of motion and, if you intend to return to sport, you will need a personalised rehabilitation plan to rebuild your strength and elbow function.
Preventing ulnar collateral ligament (UCL) injuries
While it’s not always possible to prevent accidents, you can reduce your risk of stress-related UCL injuries during sport by ensuring you use good technique and by resting the elbow sufficiently to avoid overuse. A good warm-up and cool-down before and after exercise can also reduce the risk of injury.
If you have sustained a ulnar collateral ligament (UCL) injury and would like advice about diagnosis, management of symptoms and treatment, contact us.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
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