Did you know that over 85 percent of patients who undergo ulnar collateral ligament reconstruction recover fully? The technique has been nicknamed the Tommy John surgery and for good reason – it was first used on the famous baseball pitcher in 1974.
Professional athletes are not the only ones inflicted with throbbing elbow pain. Work and overuse injuries can commonly lead to inflammation and torn ligaments in the elbow.
Reconstructive surgery is helpful in getting people back into the swing of things – no pun intended.
Ulnar Collateral Ligament
Before diving into why surgery might be beneficial for your lingering pain and inability to work – let’s look at what this ligament is and its function.
First, a ligament is a tissue that connects two bones together. When ligaments are torn (either fully or partially) then this is what can lead to what people call a “loose joint.” You might have nagging issues like instability, pain, and instability.
If a ligament is torn completely, it is more obvious the extent and damage of the injury. However, most ulnar collateral ligament (UCL) injuries are caused by repetitive movements that cause minimal damage to the ligament over time. Most times, people cannot recover a specific instant that caused the injury.
The UCL connects one side of the humerus to the ulna. In a nutshell – it helps stabilize the elbow joint. Eventually, the pain will get worse or you’ll be unable to perform certain tasks or movements.
How exactly do you tear your UCL? Very rarely does a UCL tear occur from a traumatic injury. Usually, UCL tears commonly occur with any type of throwing sport.
You can probably connect two and two together on why Tommy John surgery is frequently performed on baseball pitchers. The high-velocity movements that pitchers perform with their dominant arm slowly wear out the UCL stabilizing the elbow.
However, even though it is a common injury with a baseball pitcher, many other demographics also experience a UCL tear. Any job or hobby that requires repetitive use of the elbow, especially with torquing or twisting movements, can lead to chronic issues.
It is helpful to be aware of the three different types of tears that you can experience. A first-degree tear will cause pain, but the ligament remains firmly attached. This can usually be healed through physical therapy and rest.
A second-degree tear, as you might suspect, is further tearing of the ligament and will likely take longer to heal. In a third-degree injury, the ligament is completely torn away from the bone – this option requires surgery almost every time.
UCL Tear Symptoms
As with most injuries, the first thing you might notice with a UCL injury is pain. The body responds to an injury by causing inflammation around the area. This can be useful in bringing nutrients and blood flow to the area, but inflammation can also cause immobility and more pain.
Other symptoms can start to progress if the inflammation is left unmanaged and you neglect to rest the injured arm. Your “funny bone”, or ulnar nerve, runs right through this area.
When the swelling and injury start to compress around your ulnar nerve – you’ll know. You might have sharp zingers down your arm or light tingling and numbness in your pinky and ring finger region.
Another noticeable symptom is immobility, weakness, or a feeling of “looseness.” If your joint feels loose, this could mean you have at least a grade two tear.
If you are able to replicate this pain by performing a certain activity – such as throwing a baseball – then it is fairly indicative you have sprained the UCL.
Your orthopedic surgeon might suggest some non-surgical options before undergoing surgery. If you have a first or second-degree tear, the ligament has not been completely compromised and it is possible to strengthen and mobilize the areas around the injury.
Managing your pain and inflammation comes first. Just like an ankle sprain, you will want to treat the inflammation with the trusted R.I.C.E. acronym. This stands for rest, ice, compression, and elevation.
What is the most useful thing to do during this time? Avoiding the activity that aggravates it. It sounds simple but for many people, it isn’t totally doable. That theory holds true for most people who notice the injury doing their daily jobs.
Be aware, the soonest you report the injury to your manager or human resource coordinator, the better. It is worth it to report even minor injuries in case you need further treatment down the road.
You can also look at asking for a change in workload if you are in an environment that performs a variety of tasks.
Your physician could recommend you see a physical therapist before attempting surgery. Even if physical therapy fails to prevent surgery, it still holds plenty of benefits.
UCL tears often occur because of muscle imbalances or poor range of motion. A physical therapist can demonstrate strengthening exercises and improve your range of motion to prevent further injury to the area.
If you are not a professional athlete, a physical therapist can still address improving your posture and body mechanics. Often, overuse injuries occur because of poor body mechanics or weak muscle groups. Having the knowledge and expertise of a physical therapist can assist in prepping you before surgery.
Many times, a physical therapist will send you with a home exercise program that can be used for years to come.
Healing Through Non-Surgical Options
Is it even possible to heal a ligament? Technically yes, but it is much more difficult than a muscle strain. Due to poor blood supply and continuous stretching of ligaments, it can be difficult to properly heal it.
Unfortunately, if you have a third-degree tear, you will most likely need surgery to reattach it. It is possible for some healing to occur with first and second-degree tears to the point you might not need surgery, but you are more susceptible to further elbow injuries.
Additionally, your orthopedic specialist will likely order an X-Ray or MRI to further assess the damage to the area and the likelihood of healing through non-surgical techniques.
Ulnar Lateral Ligament Reconstruction
Under the advice of your orthopedic surgeon, you could need surgery to reinforce your UCL. What does this option look like?
Similar to knee ligament injuries, your surgeon will likely use a tendon graft during your elbow surgery. Where does this tendon come from? Usually, the surgeon will use part of your hamstring tendon because of its similarities to the UCL.
However, the surgeon could pull a graft from a different area in the body such as your knee, Achilles tendon, or hip. But – these are much less common strategies.
Your orthopedic surgeon will then remove the damaged ligament and replace it with a healthy graft. The graft is secured onto the bones with screws and anchors – sometimes parts of the original ligament can be used to reinforce it.
Surgery can help you avoid other elbow injuries, like ulnar neuropathy. Chronic inflammation and pressure on the ulnar nerve make it susceptible to flare-ups and additional nerve pain. Eventually, surgery is also necessary for individuals who are suffering daily from this debilitating pain.
As with any surgery, there are risks associated with UCL reconstruction. Pain, infection, and nerve damage can occur during surgery; however, the risk is minimal. Additionally, the most discomfort you will have is pain, stiffness, and immobility following surgery.
Make sure you thoroughly discuss the risks of surgery with your orthopedic specialist and review any medications you are currently on. Your surgeon will also prep you for the day of surgery, what to expect, and any food or water you should stop taking beforehand.
If you have any concerns about undergoing this reconstruction, express them in the appointments leading up to the surgery so that you can go in stress-free.
How long before I can throw a baseball again? Or, how long before I return to my full duties at work? These are common questions that an orthopedic surgeon receives when working with patients undergoing UCL reconstruction.
You shouldn’t go into surgery expecting to start back up full-speed the following week. In fact, it can take up to a year before the graft is fully healed. If you are in a professional sport, such as a baseball pitcher, you might not throw a full wind-up pitch for several months.
It is important to have realistic expectations before going into surgery. A new surgical graft takes time to heal, and the last thing you want is to tear your new surgical site and head back in for another surgery. This one is likely to be more taxing and in-depth compared to the first one.
Remember that physical therapy from earlier?
Now is the time to dive headfirst into rehab. Your trained physical therapist can guide and assist you on the workload placed on your elbow at various points during the recovery process. Having trained specialists on your side throughout this entire surgical and recovery process is vital to a healthy and full recovery.
Medicine is constantly evolving and as such, new surgical techniques are on the rise. Tommy John surgery notoriously takes a long time to heal because of the poor blood supply to the region. Despite having a new and healthy graft, your surgeon wants to ensure that the graft is fully healed onto the bones before giving you the all-clear.
Tommy John surgery still boasts great success rates, with up to 80-93 percent of athletes returning to their sport. However, new and improved strategies are on the rise. The newest surgical technique for a torn UCL involves an internal brace.
This technique places a “brace” over the ligament in an effort to heal the area naturally. Its goal is to attract collagen to the region – one of the essential building blocks to healing.
Some studies have even used the internal brace to further support ligament reconstruction. The goal is to improve the healing process following surgery and speed up results.
In one study, athletes were able to fully return to their sport after an average of 6.7 months of rehabilitation. This is drastic than a full year and can be crucial for some professional athletes or those in the workforce who can’t afford to slack off on heavy labor.
Type of Surgeon
There are many specialty surgical clinics in today’s medical world. While an orthopedic specialist is an ideal source to perform an ulnar collateral ligament reconstruction, it is important to do your research.
You should gear your search towards the hand, elbow, and wrist surgeons. Why? They will have the most experience working in the small enclosures found in the hand. Additionally, there are many small nerves, tendons, muscles, and tissues in these regions.
By having someone experienced who has performed multiple surgeries in these areas, you can have peace of mind that you are in capable hands. If you are suffering from further debilitating issues because of your elbow pain, such as carpal tunnel syndrome, then this makes a specialist in this area even more convenient.
Live Life Pain-Free
Dealing with chronic pain is taxing on your mental, physical, and emotional health. For many people, injuries cause high stress in their work environment. You don’t want to have to sacrifice missed workdays and constant pain.
Ulnar collateral ligament reconstruction surgery is helpful in restoring your life to the way it used to be. Whether you are a professional athlete or blue-collar worker – this surgery can give you back the life you have been missing out on.
Take the next step and reach out to a trusted specialty clinic near you that can provide you advice and guidance on your next steps to pain-free days.