Arm, Wrist, Hand, Elbow

Pitching pain in the elbow. Could it be ulnar collateral ligament (UCL) injury?

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Published on Saturday, 15 May 2010 12:32

Written by Robert G. Klitzman, M.D.

Article written by Robert Klitzman, MD, Norman OK

The ulnar collateral ligament (UCL) can become stretched, frayed or torn as a result of stress brought on by repetitive throwing motions. Most people with an injury to their UCL can do just fine without having reconstructive surgery.

While the UCL is not a ligament critical in most people’s everyday activities, it is a serious sidelining injury for athletes such as baseball pitchers, javelin throwers, ice hockey and tennis players.

Joe Nathan, also referred to as “The Closer” of the Minnesota Twins, is the most recent high profile pitcher to be sidelined by an ulnar collateral ligament (UCL) injury. To reconstruct this elbow ligament, he underwent what is commonly referred to as "Tommy John" surgery.

Ulnar Collateral Ligament (UCL) Anatomy Lesson

The ulnar collateral ligament is really comprised of three parts: The anterior (the front), posterior (the back) and transverse (the horizontal plane parallel to the ground).

These ligaments provide elbow stability to "valgus" stress. When the inside of the elbow tries to open, it stresses the elbow joint and this stress results in elbow instability. It is the anterior ligament band of the elbow that provides the most stability and it is the focus of surgery after an injury.

The mechanics of a UCL injury

If you are throwing a baseball, the extension of your elbow occurs at about 2500 degrees per second during the acceleration phase. This can actually generate more force across the UCL than it can resist.

As you might imagine, pitching often at high velocity can, over time, deliver quite a beating on the ulnar collateral ligament, which can result in micro-tears or even complete tears.

If you have pain on the inside of your elbow

People with a rupture usually notice some prior pain in the inside of the elbow due to micro tearing. In addition to pain, an athlete may experience a loss of velocity over time. Many times resting the arm can help relieve symptoms.

However, if a pitcher or thrower feels a sudden "pop" and then suffers from sudden and immediate medial elbow pain, it is probably a complete rupture of the ligament. At that point, an athlete can choose rehabilitation but that often has the frustrating result of an athlete having to play a different position.

To be able to return to throwing sports after a UCL rupture, an athlete would need to undergo a reconstruction of the UCL. Results usually improve continuously after UCL reconstruction and a number of pitchers in the major leagues have come back from this injury.

Medial elbow pain is not something you should “push through” or “tough out”. If you are a pitcher or athlete and notice pain in that area, take it seriously and get it checked out before a partial tear becomes a rupture.

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