What are the signs of Ulnar Collateral Ligament (UCL) injury?

From the Guidelines

Signs of a UCL (ulnar collateral ligament) injury include pain on the inner side of the elbow, especially during throwing or overhead activities, and can be diagnosed using dynamic stress US with a sensitivity of 96% and specificity of 81% 1.

Common Symptoms

• Pain on the inner side of the elbow
• Sudden pop or tearing sensation at the time of injury
• Swelling, bruising, and tenderness along the inner elbow
• Decreased grip strength
• Instability in the elbow joint
• Tingling or numbness in the ring and small fingers

Diagnostic Imaging

• Dynamic stress US is a useful diagnostic tool for UCL injuries, with a sensitivity of 96% and specificity of 81% 1
• MRI can also be used to assess UCL injuries, particularly in cases where the diagnosis is unclear or the injury is severe 1

Treatment

• Rest, ice, and anti-inflammatory medications can help manage symptoms
• Seek medical evaluation for proper diagnosis and treatment, which may include conservative management or surgical reconstruction (Tommy John surgery) depending on the severity of the injury

Important Considerations

• Early diagnosis is important to prevent further injury and improve treatment outcomes
• Athletes, especially baseball pitchers, are at higher risk for UCL injuries due to repetitive throwing motions
• Comparison with the asymptomatic side can be helpful in diagnosing UCL injuries, particularly when using radiographs or US 1

From the Research

Signs and Symptoms of UCL Injury

• Ulnar collateral ligament (UCL) injuries of the elbow can cause significant pain and disability in the overhead thrower 2
• Athletes with UCL injury complain of acute or chronic medial elbow injury, resulting in decreased throwing effectiveness, with loss of control and/or velocity 3
• Injury to the UCL will render throwing difficult to nearly impossible 4

Diagnosis of UCL Injury

• Imaging modalities that have the greatest accuracy for diagnosis include magnetic resonance imaging (MRI), MRI-arthrogram, and stress ultrasonography 4
• Magnetic resonance imaging is the gold standard for diagnosis, but stress ultrasound rapidly is becoming an important adjunct, particularly in diagnostically challenging situations 3
• Careful history taking, thorough physical examination, and judicious diagnostic imaging allow clinicians to correctly diagnose ulnar collateral ligament (UCL) injury 3

Common Sports Affected by UCL Injury

• UCL injuries are common in throwing athletes, particularly in baseball, softball, and javeliners participating in track and field 4
• UCL injuries can also occur in professional football quarterbacks, although they are less common in this group 2