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Non-Operative Treatment


Typically those who have low-moderate grade sprains to the UCL and are not throwing athletes will undergo conservative treatment.

 

Conservative treatment focuses on: 

  • Developing structural stability

  • Range of motion

  • Strengthening the injured extremity

 

The acute injury phase focusing on the R.I.C.E principle and taking non-steroidal medications such as Ibuprofen for pain management. The use of modalities such as electrical stimulation, iontophoresis, phonophoresis, and non-thermal ultrasound can aid in swelling and pain management.

 

After decrease in swelling, increase in stability and proper pain control has been achieved, the patient can engage in physical therapy to progressively strengthen the area. 

 

 

Operative Treatment

 

Operative treatment focuses on two aspects of surgical intervention: repair of the existing ligament or replacement with a tendon graft.

 

Repair of the existing ligament is only performed when the UCL ligament has avulsed from the bone (meaning the ligament can be fixated back into its original resting position on the bone). If the ligament itself tears, it is impractical to fixate a ligament back together; this is due to the small size and nature of the ligament. Typically ligaments that are avulsed can be fixated to the bone through an arthroscopic procedure.

 

Re-attachement of the ulnar collateral ligament to the proximal ulna would involve suturing the ulnar collateral ligament to the bone. Care must be taken in removal of any debris from the avulsion. Placement of the ligament is crucial in structural integrity of the joint and can risk re-injury or potential new injuries if tension is lacking or exceeding original ligament tension.
 

Replacement of the UCL is the most widely known surgical procedure, otherwise known as Tommy John surgery. In this procedure the ulnar collateral ligament is replaced with a tendon taken from another location within the body. Common places for tendon graft extraction include the wrist/forearm (palmaris longus), latissimus dorsi, hamstring, knee or foot. The extraction of one’s own tendon is known as an autograft.

 

A common surgical technique used for ligament replacement is known as the docking technique:

  1. The surgeon will drill two holes in the ulna and three holes in the medial epicondyle of the humerus. The two holes of the ulna will form a tunnel for the tendon graft to be looped through

  2. A triangle is formed with the three holes in the medial epicondyle; the tendon graft is threaded through the bottom hole and pulled through the two top holes of the triangle.

  3. Sutures are attached to both ends of the tendon graft and pulled until tension is appropriate to hold the joint in position. 

Treatment options for UCL tears

Case Study (cont.)

 

Our athlete was treated conservatively. He was given the option of surgery, but because he only had a partial tear he elected to begin rehabilitation. He was given a prognosis of being able to return to full play in approximently four to six weeks.

Outcomes

Non-Operative:
Patient's who do not participate in competitive sports at a high skill level often see good results with this type of treatment. However, this treatment is not recommended for those with more severe ulnar collateral ligament sprains or patients who participate in high level of activity. In the modern day and age college and professional athletes are required to perform at a high skill level to maintain their scholarship/job. General rehabilitation of the ulnar collateral ligament will prove very difficult in maintaining the appropriate skill level. The typical timeline for a moderate sprain to the ulnar collateral ligament conservative treatment is 6-9 months, while minor sprains to the ulnar collateral ligament can be treated effectively 2-3 months, however this is a approximate timeline and primarily depends on the persons grade of injury, their personal levels of activity, and lastly their career choice. The specific time frames of treatment progression will be outlined in the rehabiliation section. 

 

 

Operative:
Patient's who were involved in high level athletics underwent this form of treatment showed that 83% had returned to play following the two year check-up mark. Typically statistics vary between 75-85% success rate both in reconstruction and repair of ulnar collateral ligament. This surgery has a relatively high sucess rate, and a large part of sucess comes from the patients following up with appropriate rehabilitation. Treatment time line for reconstruction or repair of the ulnar collateral ligament will be approximately 9 months. Remember this is dependent on many factors and each individual is unique in their own healing process. The progression of rehabilitation throughout this timeline will be outlined in the rehabilitation section. 

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