Ulnar Collateral Ligament Injuries (Tommy John)

Ulnar collateral ligament (UCL) injuries are most common in throwing athletes, especially baseball pitchers. The UCL is a ligament complex on the medial (inside) part of the elbow that helps to stabilize the joint. Pitching in baseball puts a tremendous amount of strain on the ligament and can often cause it to rupture. The tear usually is noticed immediately by the pitcher (or thrower) and often will cause an audible pop. Protecting the ligament in younger pitchers is one of the reasons for the strict pitch count that little-league pitchers should follow during their seasons. The ligament can be torn in other athletes and other circumstances as well (such as with an elbow dislocation). Most athletes (including football quarterbacks) with an UCL tear do not need surgery as the stability of the elbow may not be compromised after this injury. Throwing a football is entirely different than pitching a baseball, so, while baseball pitchers with an UCL tear may notice a decrease in their speed and accuracy, football quarterbacks may not have any problems. The UCL is usually reconstructed for baseball pitchers and a few other select athletes (gymnasts, who put a high degree of stress on the inner aspect of their elbow; wrestlers and javelin throwers, for example). Surgical treatment of the injury involves reconstructing the ligament either with a tendon from the athlete or a cadaver tendon graft. Return to full throwing for pitchers is a long process and can take up to a year from the surgery. Dr. Walker will discuss your options and help you make the best decision based on your injury and your lifestyle.

Ulnar Collateral Ligament Tear Diagram

A brief note about prophylactic fixation of this ligament. Several recent news articles published in various newspapers around the country have discussed “reinforcing” the ulnar collateral ligament in young throwers before it actually tears. In general, surgery for a problem that has not happened is not a good idea and there is no literature in the Orthopaedic community that currently supports this practice.