ElbowWrist

Tears of the Ulnar Collateral Ligament of the Elbow

By October 17, 2019 November 20th, 2019 No Comments

Like all joints in the human body, the elbow is a fairly complex network of tissues that work together harmoniously in order to enable the dexterity we are used to. In the elbow, none of these tissues is as important for its movement as the ligaments.

One such ligament, known commonly as the ulnar collateral ligament (UCL), is much more prone to injury over its neighboring tissues.

If you believe you may have suffered an injury to your UCL, read on to learn more about what to expect.

Anatomy of the Ulnar Collateral Ligament of the Elbow

The ulnar collateral ligament is a set of tissues that connects and fastens a bone in the lower arm (ulna) to the bone in the upper arm (humerus). This set of tissues is made up of three parts:

  • Anterior Band
  • Intermediate Band
  • Posterior Band

As these names imply, the UCL is made up of three bands that rest on each other.

The posterior band lies beneath the other two and stretches from the end of the humerus to the base of the ulna in a sprawling, triangular shape. Out of the three, it provides the most stability when extending the elbow.

The intermediate band is a thin mesh of fibrous tissue which rests along the end of the ulna. This tissue overlaps the long end of the posterior band and helps transition its force for rotational movement. The intermediate band of the UCL stabilizes rotational movement at the elbow and helps keep the rounded edge of the humerus from slipping out of the pocket created by the bones in the lower arm.

Finally, the anterior band of the UCL shares an origin point with the posterior band, but rather than end at the base of the lower arm bones, this band stretches further and connects to a more forward portion of the ulna. This band of tissue provides the most momentum out of the three for extending and tightening the elbow.

Together these three bands form the UCL and help provide movement to the elbow through their constriction and relaxation. An injury to any single portion of the UCL will have adverse consequences to the other two portions and the elbow at large. The most common of these injuries lead to micro-tears in these fibrous tissues, and over time, through daily activity, these tears develop in full-on rips which can lead to a number of adverse symptoms.

Causes of Tears of the Ulnar Collateral Ligament and Pain in the Elbow

UCL injuries are fairly common, especially in athletes whose sport of choice involves overhead throwing or in laborers whose jobs involve extreme load bearing on the elbow.

Typically, UCL injuries come in the form of microtears to the fibrous bands which make it up. These microtears can develop as a result of overextension, overexertion, or blunt trauma. Some of the most likely causes are:

  • Catching a fall with an extended elbow
  • Overbearing loads on the elbow, especially for long periods of time such as in labor-intensive careers
  • Direct hits to the side of the elbow from any hardened object
  • Overextension due to pitching a baseball, throwing a football, or an especially intense game of tennis

Once microtears have developed, continued exposure to the inciting factors will make them deeper and wider until they become full-on tears. Even everyday use of the elbow can cause these microtears to expand. Once they are present, the only combative techniques against their progression are rest and time. If these injuries do develop into something larger, an individual will begin to experience a wide range of symptoms.

Symptoms and Signs of Tears of the Ulnar Collateral Ligament of the Elbow

As UCL injuries develop, an individual will begin to experience a number of symptoms which could indicate more severe consequences down the road.

If you believe you’ve suffered an injury to the UCL, watch out for these common symptoms:

  • Pain
  • Swelling
  • Instability
  • Reduced load bearing capability
  • Reduced range of motion
  • Tenderness at the sides of the elbow

In the initial stages of an injury, these symptoms will express themselves slowly. An individual may be able to continue with their daily activity, but strenuous physical exertion will present limitations. Over time, these symptoms will develop into a chronic problem. If these symptoms have begun to present themselves, it may be time to seek professional assistance.

Diagnosing Tears of the Ulnar Collateral Ligament

Diagnosis for a tear in the UCL tissue comes in three parts:

  • Medical history evaluation
  • Physical examination
  • Medical imaging

Doctors will begin by examining the patient’s medical history. Have there been any signs of trouble relating to the elbow up until now? Has the patient suffered any trauma to the elbow or surrounding regions in the past? Have previous examinations shown peculiarities within the structures of the elbow?

A doctor must take all of these issues into account before they can pinpoint the precise reason for a patient’s elbow discomfort.

Once the doctor has established a UCL tear as a probable cause of the patient’s pain, they will perform a physical examination. There are various tests a doctor can conduct in order to rule out other possibilities, but the most common is fairly simple.

The doctor will simply place a small amount of pressure on the side of the elbow, right where the UCL should be. Next, they will slowly push and pull the lower arm inwards and outwards in order to recreate the symptoms a patient has been feeling. Depending on how much pressure needs to be applied to the UCL and how much pain the test creates, a doctor will accurately be able to measure the progression of the tear.

Finally, with all other tests concluded, the doctor will choose one, or several, medical imaging tests in order to get an inside view of the elbow and its tissues. The most common and detailed test if a UCL tear is suspected is a magnetic resonance imaging (MRI) scan. This not only provides doctors with a view of the UCL but also the state of the other soft tissues within the elbow.

Degeneration of any of these soft tissues may be another inciting factor for a patient’s pain, instability, swelling, and other symptoms. If the UCL is torn, this will lead to malalignment of the bones within the elbow which may lead to breaking down of the protective patches of cartilage which line the rims of each bone.

If these tests prove conclusive, the doctor will move on to examining the patient’s functional goals and try to define a clear path to achieving those goals through conventional treatments.

Conventional Treatments for Tears of the Ulnar Collateral Ligament and Pain in the Elbow

Conventional treatments for UCL tears are those treatments that have been most studied and therefore are the most typically recommended by doctors. These treatments include physical therapy, medication, steroidal injections, and, in advanced cases, surgery.

Physical Therapy

Physical therapies aim to restore function and reduce pain via physical methods. Treatments such as massage, guided exercise, stretching, rest, compression, and hot/cold therapy all fall into this category. The benefit of physical therapies for most patients is the fact that they can be done at home, on the go, or with trained professionals. All levels of physical therapy have been shown to help treat pain and reduce flare-ups of symptoms in some way.

Medication

Most patients will have already tried a number of over-the-counter medications before consulting a doctor for further assistance. Ibuprofen, naproxen, and acetaminophen are the generic versions of popular name brands that help to reduce inflammation and increase blood flow. These medications aim to stop the painful constriction of the nerves within the elbow after a UCL tear and help patients regain a bit of their mobility without having to move on to more advanced treatments.

If the progression of the tear has become too severe for these medications to have any helpful effect, doctors may move on to prescribing medications aimed at blocking the brain’s ability to interpret pain signals. It should be noted that none of these medications will help to treat the actual cause of the pain, but simply alleviate the symptoms of the tear.

Steroidal Injections

Another popular treatment for pain related to the UCL are steroidal injections. Like over-the-counter medications, these treatments are aimed at reducing swelling and increasing blood flow within the elbow.

While these treatments are effective at counteracting the body’s natural defense mechanisms, in recent years these treatments have come under fire for their degenerative effects. It has been shown that prolonged use of steroids can lead to adverse effects that actually progress the issues they are trying to combat.

While steroidal injections may seem like a cure-all, patients should do their research before attempting their applications.

Surgery

Surgery is a last resort for only the most advanced cases of UCL injury, and with good reason. These surgeries rarely work out to the benefit of the patient. While they may reduce the pain a patient feels, the side-effects – a reduced range of motion, long recovery periods, bouts of physical therapy and medication – may simply not be worth it for a patient.

If surgery is ultimately the patient’s choice, it typically involves a procedure known as Tommy John’s surgery, named for the first person to ever receive the treatment. The procedure is applied when the ligament has completely torn off the bone. By making an incision on the inside of the elbow and reattaching the ligament to the bone using sutures, the ligament may heal back into place.

If the UCL is completely degenerated, reconstruction surgery may take place. By extracting and grafting a portion of the ligament in the wrist (Palmaris Longus), the new tissue may become a suitable replacement for the degenerated UCL.

Though conventional treatments are the most commonly recommended, they are not always the right choice given a patient’s lifestyle and their functional goals. Additionally, if these treatments simply fail to help a patient after they’ve already been performed, the patient will want to seek another route.

Thankfully, there are a number of alternative treatments at the disposal for patients who fall into this category. One such treatment, regenerative therapy, is quickly making a name for itself due to its relatively easy application and noteworthy results.

Regenerative Therapy for Tears of the Ulnar Collateral Ligament and Pain in the Elbow

Unlike conventional treatments, regenerative therapies are focused on treating the cause of the pain, rather than the pain itself. As the name implies, regenerative therapies are treatments which attempt to restore damaged tissues. By using either platelet rich plasma or stem cells derived from a patient’s own tissues, CELLAXYS has been able to successfully treat over 30,000 patients with a variety of soft-tissue related disorders.

PRP Therapy

Platelet rich plasma is a treatment in which the platelets in a patient’s blood are isolated and reapplied into the site of a patient’s injury. Platelets are one of the body’s natural defenses against injury. They form into clots and clusters which stop bleeding and the progression of further injury. Once clotted up, these cells send out chemical impulses that attract other healing factors to an injury. As these factors culminate, they begin to repair tissues that are damaged thereby returning dexterity and reducing the pain a patient feels.

Stem Cell Therapy

Recent advancements in the field of stem cell science have led to the discovery of pseudo-stem cells derived from bone marrow and fat tissue. These “new” stem cells are known as mesenchymal stem cells and they have the potential to alleviate any soft-tissue related injury throughout the body. By injecting these cells into a patient with a mix of other growth factors, these injections are able to awaken and amplify the body’s own repair mechanisms and incite new repairs around an injury.

Together, these treatments form the basis of the regenerative therapies we offer at CELLAXYS. The benefits to these treatments over conventional methods are:

  • Reduced downtime – most patients report side effects waning within a week after injections
  • Longer effectiveness – treatments are known to alleviate symptoms in patients for six months to a year on a single injection
  • Reduced invasiveness – application of the treatments is a simple outpatient procedure with minimal side-effects (light swelling and stiffness after injection)

Additionally, these treatments not only help alleviate the pain caused by soft tissue injuries but also help to repair the injury itself, conventional treatments don’t.

Conclusion

UCL injuries put a constant burden on individuals who experience them. By reducing the individual’s ability to use their elbow properly, these injuries drastically impact the lifestyle they can lead. Conventional treatment options may be enough to help those who have caught these injuries early enough, but for others, they simply don’t work. Regenerative therapies offer an alternative that may be able to help where conventional treatments could not.

If you would like to set up a consultation to learn more about what regenerative therapies are and how they may be able to help your injury, contact the CELLAXYS offices today. Our offices are always open to discussion and our number one goal is to help patients reach their functional needs and reduce their pain.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni