Ulnar Collateral Ligament Injury of the Elbow

with Rehab

Ulnar collateral ligament injury of the elbow is a sprain (tear) of one of the ligaments on the inner side of the elbow. The ulnar collateral ligament (UCL) is a structure that helps keep the normal relationship of the upper arm bone (humerus) and the one of the forearm bones (ulna). This ligament is injured in throwing types of sports or after elbow dislocation or surgery. It may occur as a sudden tear or may gradually stretch out over time with repetitive injury. This ligament is rarely stressed in daily activities. It prevents the elbow from gapping apart on the inner side. When torn, this ligament usually does not heal or may heal loose in a lengthened position. Sprains are classified into three grades. In a first-degree sprain, the ligament is not lengthened but is painful. With a second-degree sprain, the ligament is stretched but still functions. With a third-degree sprain, the ligament is torn and does not function.

SYMPTOMS

  • Pain and tenderness on the inner side of the elbow, especially when trying to throw.

  • A pop, tearing, or pulling sensation noted at the time of injury.

  • Swelling and bruising (after 24 hours) at the site of injury at the inner elbow and upper forearm if there is an acute tear.

  • Inability to throw at full speed; loss of ball control.

  • Elbow stiffness; inability to straighten the elbow.

  • Numbness or tingling in the ring and little fingers and hand.

  • Clumsiness and weakness of hand grip.

CAUSES

Ulnar collateral ligament injury is caused by a force that exceeds the strength of the ligament. This injury usually is the result of throwing repetitively or particularly hard. It may occur with an elbow dislocation or as a result of surgery.

RISK INCREASES WITH:

  • Contact sports (football, rugby) and sports in which falling on an outstretched hand results in an elbow dislocation.

  • Throwing sports, such as baseball and javelin.

  • Overhead sports, such as volleyball and tennis.

  • Poor physical conditioning (strength and flexibility).

  • Improper throwing mechanics.

PREVENTION

  • Appropriately warm up and stretch before practice and competition.

  • Maintain appropriate conditioning:

  • Arm, forearm, and wrist flexibility.

  • Muscle strength and endurance.

  • Use proper protective technique when falling and throwing.

  • Functional braces may be effective in preventing injury, especially re-injury, in contact sports.

PROGNOSIS

The UCL usually does not heal sufficiently on its own with non-operative treatment. To return to throwing, surgery is often necessary.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, such as an inability to throw at full speed or distance, pain with throwing, and loss of ball control, especially if activity is resumed too soon after injury.

  • Injury to other structures of the elbow, including the cartilage of the outer elbow.

  • Loose body formation.

  • Injury to the ulnar nerve of the hand.

  • Medial epicondylitis (pain and inflammation on the inner side of your elbow).

  • Strain of the muscle-tendon of the muscles that bend the wrist.

  • Arthritis of the elbow from injury to cartilage.

  • Elbow stiffness (loss of elbow motion).

TREATMENT

Initial treatment consists of medicine and ice to relieve pain and reduce the swelling of the elbow. You must stop participating in the sport that caused the injury. Occasionally a splint, brace or cast may be recommended while the severe (acute) phase subsides. Later, rehabilitation to improve strength endurance and proper throwing mechanics is initiated. This may be carried out at home, although usually referral to a physical therapist or athletic trainer is recommended.

Gradually return to throwing. Returning to sports without surgery may take 3 to 6 months and may take 6 to 18 months following surgery.

Surgical reconstruction (rebuilding the ligament using other tissue) is usually recommended:

  • For those who have an acute rupture of the ligament.

  • When therapy has not worked and you wish to continue throwing competitively.

MEDICATION

  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your caregiver. Contact your caregiver immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

  • Stronger pain relievers may be prescribed as necessary by your caregiver. Use only as directed.

HEAT AND COLD

  • Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage). Use a towel between the ice and your elbow to reduce the chance of injury to the ulnar nerve at the inner elbow.

  • Heat may be used before performing stretching and strengthening activities prescribed by your caregiver. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Ulnar Collateral Ligament Injury of the Elbow

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can using your right / left arm muscles.

  • Straighten the right / left elbow farther by gently pushing down on your forearm until you feel a gentle stretch. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Flexion

  • Hold your right / left arm at your side and bend your elbow as far as you can using your right / left arm muscles.

  • Bend the right / left elbow farther by gently pushing up on your forearm until you feel a gentle stretch. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION – Elbow Flexion, Supine

  • Lie on your back. Extend your right / left arm into the air, bracing it with your opposite hand. Allow your right / left arm to relax.

  • Let your elbow bend, allowing your hand to fall slowly toward your chest.

  • You should feel a gentle stretch along the back of your upper arm and/or elbow. Your physician, physical therapist or athletic trainer may ask you to hold a __________ lbs hand weight to increase the intensity of this stretch.

  • Hold for __________ seconds. Slowly return your right / left arm to the upright position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Elbow flexors

  • Lie on a firm bed on your back. Be sure that you are in a comfortable position which will allow you to relax your muscles.

  • Place a folded towel under your upper arm so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caretaker may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Ulnar Collateral Ligament Injury of the Elbow

  • These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Elbow Flexors, Neutral

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your thumb facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Elbow Extensors

  • Lie on your back. Extend your right / left elbow into the air, pointing it toward the ceiling. Brace your arm with your opposite hand.*

  • Holding a __________ weight in your hand, slowly straighten your right / left elbow.

  • Allow your muscles to control the weight as your hand returns to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

*You may also stand with your elbow overhead and pointed toward the ceiling and supported by your opposite hand.

STRENGTH - Elbow Extensors, Dynamic

  • With good posture, stand or sit on a firm chair without armrests. Keeping your upper arms at your side, bring both hands up to your right / left shoulder while gripping a rubber exercise band/tubing. Your right / left hand should be just below the other hand.

  • Straighten your right / left elbow. Hold for __________ seconds.

  • Allow your muscles to control the rubber exercise band/tubing as your hand returns to your shoulder.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your opposite arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.