Does the inside of your elbow hurt? Is it a (UCL) injury? Let's talk about this!

Have you ever felt pain on the inside of your elbow while bowling, playing volleyball, or doing any heavy lifting? Sometimes, you can get this sharp pain when you fall and hit your hand or when you hit your elbow somewhere. Most of the time, this is caused by damage to the Ulnar Collateral Ligament (UCL) in your elbow. This is actually a strong band of tissue that helps keep your elbow joint stable and straight. It's like a rubber band, but it's stretchy, but it's strong.

What exactly is this `(UCL)`? How does it work in the elbow?

Simply put, the UCL is a strong band of tissue on the inside of your elbow, on your body side. To be precise, it is a ligament. A ligament is a strong band that connects bones together. Its main function is to keep your elbow joint stable when you throw something up, for example, when you throw a cricket ball or play volleyball. It also stops your elbow from swinging back and forth unnecessarily.

Now look, our elbow joint is made up of three bones. The big bone in your upper arm, we call it the `(Humerus)`, and the two bones in your lower arm, that is, the part below the elbow – the `(Ulna)` and the `(Radius)`. This `(UCL)` is on the inside of the elbow, that is, on the side where your little finger is. It also has three parts – an `(anterior band)`, a `(posterior band)` and a `(transverse band)`. The most important of these three is the anterior band . It helps keep the elbow stable the most.

How are `(UCL)` injuries classified?

Injuries to this ``UCL'' ligament, or ``sprains'' as we call them, are mainly classified into three degrees. This classification is done according to the extent of the damage.

• Grade 1: This is a strain on the ligament, but not a tear. There may be some pain and swelling.
• Grade 2: The ligament is stretched, and possibly partially torn . The pain is a little more intense, and the elbow may feel a little unstable.
• Grade 3: This is the most severe case. Here the ligament is completely torn . Sometimes it can even detach from the bone.

What are the symptoms of a UCL injury?

Symptoms also vary depending on the severity of the disorder.

Symptoms of a minor or moderate disorder:

• Pain on the inside of the elbow and a feeling of soreness when you rub your arm. Especially after doing something that involves lifting your arm, like after a cricket match.
• Pain when moving the arm forward quickly (e.g., throwing a ball).
• The elbow feels weak, loose, and not strong enough.
• A feeling of weakness when holding something in your hand, as if you can't hold it, or like you're dropping the item.
• Not being able to throw anything as fast or as hard as before.

Symptoms when the ligament is completely torn:

• A sudden pain on the inside of the elbow with a "pop" sound , as if something had exploded.
• Very severe pain.
• Being unable to throw anything away.
• Sometimes you may experience numbness or a loss of feeling in your little finger or ring finger. This means that your ulnar nerve has been damaged or pinched.

What are the causes of UCL injuries?

There are two main reasons why these `(UCL)` injuries occur. One is continuous stress on the elbow (we call it `(Overuse)`), and the other is a sudden accident `(Trauma)`.

Overuse injuries

This is often the reason why UCL injuries occur. Repeated overhead movements, such as a cricketer bowling or a volleyball player spike, put pressure on this ligament. Over months, or even years, the UCL gradually stretches, becomes injured, and small tears (microtears) develop. Eventually, the elbow joint becomes loose and unstable. The ligament may become swollen, partially or completely torn, or one end of the ligament may detach from the bone.

Traumatic injuries

These are not caused by long-term use. They can be caused by a sudden blow to the elbow, such as a fall. For example, you fall and reach out and grab the ground, thinking "to stop the fall." Then the elbow can ``dislocate'', meaning the joint is broken, or the bone can ``fracture''. At times like these, there is a high chance that the ``UCL'' will also be damaged.

Will a UCL injury make you unable to use your arm?

Usually, a UCL injury will not have a significant impact on your daily activities, such as lifting a bag or lifting objects that do not involve throwing. However, you may not be able to participate in throwing sports or other heavy lifting activities that require you to hold your arm up.

How do you accurately diagnose a UCL injury?

When you see a doctor, usually an orthopedic specialist or a sports medicine specialist, he or she will ask you about your medical history and any sports you play. Then they will do a physical exam.

In this test,

• How far you can bend and extend your elbow is called ``range of motion''.
• Elbow strength is tested.
• Checks the stability of the elbow.
• The condition of the muscles of the hand is checked.
• Maybe they'll check the shoulder too.
• They also ask where exactly the pain is.

In addition, the doctor may order tests such as:

• Valgus stress test: This is a physical test. The doctor will raise your forearm about 30 degrees, place his fingers on your UCL, and apply pressure to the inside of your elbow and the outside of your forearm. If you feel pain along with a looseness in the elbow joint, this may indicate a UCL injury.
• CT Scans (Computed Tomography - CT) and X-rays: These imaging tests can look at the condition of bones, such as stress fractures. However, they cannot directly see soft tissues such as the UCL.
• MRI scan (Magnetic Resonance Imaging - MRI): This can clearly see damage to soft tissues such as tendons and ligaments. It can also detect small bone fractures that cannot be seen on X-rays.
• Arthrogram: This is similar to an MRI scan, but a special dye is injected into the elbow joint before the scan. This allows for clearer images of even difficult-to-find problems.

How is a `(UCL)` injury treated?

Treatment depends on the severity of your UCL injury and how much overhead work or throwing you expect to do. If you have a small UCL tear, it will likely heal on its own. Nonsurgical treatments can help reduce pain.

Non-surgical treatments:

• Rest: This is the most important thing. You need to take a break from activities that put stress on your elbows for a while.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Examples include ibuprofen (Advil®, Motrin®) and naproxen (Aleve®). These reduce swelling and pain. If necessary, you can get a stronger NSAID that your doctor recommends.
• Ice: Apply ice to your elbow for 15-20 minutes several times a day. This will reduce pain and swelling.
• Physical therapy: Special exercises are needed to strengthen the muscles around the elbow. This will increase the support provided to the elbow.
• Platelet-Rich Plasma (PRP) Injection: This involves taking a small amount of your own blood and separating out a type of cell called platelets. These platelets are then injected into the area of ​​the damaged UCL. These platelets have healing properties, so they can be helpful for people who have a torn UCL.

Surgical treatments:

• UCL direct repair: If your UCL ligament has torn away from the bone in a sudden accident, it may be possible to reattach it to the bone.
• UCL reconstruction (Tommy John surgery) : If your UCL is unstable or completely torn, and nonsurgical treatments do not relieve pain, or if you are an athlete and continue to play throwing sports or do heavy lifting, your doctor will often recommend UCL reconstruction surgery.

In this procedure, the surgeon takes a tendon from another part of your body (e.g., your leg, arm) or a tendon from a donor and attaches it to the ulna and humerus bones of your elbow to create a new UCL. Sometimes, the remaining part of the old UCL is grafted into the new joint to strengthen it.

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The main goals of surgery are to restore stability and range of motion to the elbow, increase strength in the elbow, and relieve pain.

Why is this `(UCL)` reconstruction surgery called `(Tommy John Surgery)`?

This is a very interesting story. This surgery is named after the first person to have it done. Tommy John is a famous Major League Baseball player who tore his (UCL) ligament in 1974. He was out of the game for about a year, but he was the first player to have this surgery and successfully return to baseball. So the surgery is named after him in his honor.

What tendons are most commonly used for UCL reconstruction?

One of these tendons is usually used for the graft:

• A tendon at the back of the thigh (Hamstring tendon)
• The tendon in your lower hand called the ``Palmaris longus tendon'' (this doesn't happen to everyone)
• A tendon that helps lift the big toe upward (Big toe extensor tendon)

What are the complications of UCL reconstruction surgery?

As with any surgery, there are risks of infection and problems with anesthesia.

In addition, there are complications specific to UCL reconstruction:

• The newly inserted graft may pull or tear again. If this happens, a second surgery will be required to insert a new graft.
• Ulnar nerve damage. Because this nerve passes through the elbow joint, the surgeon may need to move the nerve to the front of the elbow joint to prevent further damage.

How to reduce the risk of a UCL injury?

Proper preparation, learning proper elbow technique, and resting when you feel pain or discomfort in your elbow can help prevent UCL injuries.

Especially athletes who:

• Get proper training: Learn how to throw correctly and how to use your hand.
• Pitch count limit: Avoid throwing too many pitches at once.
• Get proper rest: Give your muscles and ligaments time to heal.
• Do stretching and strength training: These strengthen the muscles around the elbow.
• Avoid sidearm throwing: This puts more pressure on the elbow.

How long does it take to recover from a UCL injury?

This also varies depending on the severity of the disorder and the treatment method.

Without surgery:

If you have a UCL tear, it can take anywhere from a few weeks to a few months to heal. This time depends on how much movement you want to regain in your elbow.

After `(UCL)` reconstruction surgery:

It can take 9 months to a year, or even longer, to heal. You may need to wear a special brace to help increase your elbow's range of motion. If you plan to return to high-impact sports, you will need to undergo a physical therapy and pain management program that is tailored to you. This will help strengthen your elbow and improve your range of motion and function.

How can we help protect school athletes from injuries caused by long-term use like this?

Here are some things you can do to protect young athletes from overuse injuries:

• Get a medical checkup before the sports season: This can help identify health problems early that could lead to long-term disabilities.
• Learn the correct throwing technique: It is important to learn it properly from a coach.
• Keep a limit on the number of balls thrown in a single match.
• Engage in a year-round fitness program: This should include stretching and strengthening exercises.
• Be sure to do warm-up and cool-down exercises before and after sports activities.
• Never play or train if you are injured or in pain.
• Avoid playing the same sport year-round: Encourage young athletes to take breaks once in a while. This will give muscle groups, tendons, and ligaments that are used in the same way a break.

What is `(Little Leaguer's Elbow)`?

This is a condition that affects the elbows of young children, especially school-age children. It is actually a disorder of the growth plates. The growth plates are the parts of the bones that make up the elbow joint. Because the bones of young children are still growing, these growth plates are weaker than other parts of the bone, ligaments, and tendons. The most stress during throwing comes to this weakest point, the growth plate. This stress can damage the tissues and bones of young athletes when they are thrown continuously. If your young athlete complains of elbow pain, be sure to have them examined by a doctor, an orthopedic surgeon, or a sports medicine specialist.

Finally, things to remember

Ulnar Collateral Ligament (UCL) injury is an injury to the inside of the elbow. It is mainly caused by long-term overuse. Although it is most commonly seen in baseball players, it can occur in anyone who does heavy lifting with their arms raised. The main symptoms are pain in the elbow and tenderness when the arm is touched. Some people may experience a sudden, "clicking" pain on the inside of the elbow.

If you are not an athlete or do not do heavy lifting, your elbow may heal with simple treatments such as rest, ice, medication, and physical therapy. However, more severe injuries and athletes may need surgery, such as Tommy John Surgery. Depending on the severity of your injury and how much overhead work you want to do, you and your doctor can decide the best course of treatment. Therefore, if you have elbow pain, it is important to seek medical advice without ignoring it.

` Elbow pain, UCL injury, Tommy John surgery, sports injuries, ligament tears, elbow surgery, physical therapy