From the Guidelines
For a UCL tear, treatment should prioritize conservative management with rest, ice, anti-inflammatory medications, and physical therapy for 6-12 weeks, before considering UCL reconstruction surgery, as this approach can effectively reduce morbidity, mortality, and improve quality of life. When managing a UCL tear, it's crucial to consider the severity of the injury and the patient's athletic goals, as this influences the treatment plan 1. Key considerations in the management of UCL tears include:
- Early symptoms such as inner elbow pain during throwing, decreased performance, and instability
- The importance of proper diagnosis, which may involve radiographs to show intra-articular bodies, heterotopic ossification, osteochondral lesion, soft tissue calcification, occult fracture, or osteoarthritis, and can aid in the diagnosis of valgus instability and UCL injury 1
- Conservative treatment options, including rest, ice, anti-inflammatory medications (like ibuprofen 400-600mg three times daily for 1-2 weeks), and physical therapy focusing on strengthening and flexibility exercises for 6-12 weeks
- The potential need for UCL reconstruction surgery (Tommy John surgery) in cases of complete tears or failed conservative treatment, particularly in competitive athletes, followed by a 9-12 month rehabilitation period. It's also important to note that without proper treatment, UCL tears can lead to chronic pain, instability, and potentially career-ending limitations for athletes who rely on overhead throwing motions.
From the Research
UCL Tear Overview
- Ulnar collateral ligament (UCL) injuries are common in overhead athletes, particularly baseball players, and can be career-ending if not treated properly 2, 3, 4, 5, 6.
- The incidence of UCL injuries continues to rise, with certain risk factors identified, including pitch velocity, fewer days between outings, and overall workload 3.
Treatment Options
- Treatment of UCL injuries depends on the type of tear, with low- to medium-grade partial UCL tears (grade I or II tears) usually amenable to a period of rest and a graduated throwing program 3.
- Platelet-rich plasma (PRP) injections have been described as another treatment modality to consider in throwing athletes with partial UCL tears, although robust clinical data are currently lacking 3.
- UCL reconstruction remains the gold standard for operative management of a complete UCL tear, with return-to-play rates between 80% and 90% 3.
Nonoperative Management
- Nonoperative management of partial UCL injuries can be effective, with return-to-play (RTP) rates ranging from 42% to 100% (mean, 78% ± 20%) 5.
- A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program 5.
- Factors such as age, grading of tear, level of play, sport, and athlete's perceived well-being should all be considered during treatment decisions 5.
Return to Sport
- The overall return to sport (RTS) rate after nonoperative management of UCL injuries is 79.7%, with the overall return to previous level of play (RTLP) rate being 77.9% 6.
- Increasing UCL injury severity grade is associated with lower RTS rates, and the RTS rate for proximal tears is significantly greater than that for distal tears 6.
- Athletes are most commonly treated with PRP injection and physical therapy, with no significant difference in RTS rate seen in patients treated with PRP versus those who did not receive PRP 6.