An ulnar collateral ligament injury, such as a sprain or tear, is an injury to one of the ligaments on the inside of the elbow. The ulnar collateral ligament is a structure that helps maintain normal interaction between the humerus and the ulna (one of the bones of the forearm). This ligament is injured during throwing (certain sports) or after elbow dislocation or surgery.
The damage can be a sudden rupture or a gradual stretching of the ligament due to repeated injuries. This ligament is rarely damaged by daily activities. The ligament prevents the elbow from twisting inward. When a ligament ruptures, as a rule, independent healing does not occur, or as a result of regeneration, the ligament lengthens.
Sprains are divided into three degrees. In the first degree of sprain, the ligament is not elongated, but painful. In a second-degree sprain, the ligament is stretched but still functional. In a third degree sprain, the ligament is torn and does not work.
Risk factors
Most injuries occur in the CL when throwing objects overhead, especially in baseball players. Typically, the injury is caused by repeated overuse, which ultimately weakens the ligament significantly and eventually leads to its rupture. Other risk factors include:
- Contact sports (football, rugby) and sports in which falls on an outstretched arm occur, which often leads to dislocations.
- Throwing sports such as baseball and javelin throwing
- Sports that involve overhead arm movements (volleyball and tennis)
- Poor physical condition (weak muscle strength and flexibility)
- Incorrect throwing mechanics
Criteria for evaluation
For elbow ligament injuries, three generally accepted methods are used to assess patient-reported outcomes:
- Disabilities of the Arm, Shoulder and Hand (DASH) is a 30-question questionnaire with a score ranging from 0 to 100, with 0 being no limitation. The DASH is well studied and valid with minimal clinically significant differences; either a 15-point clinically minimally important difference (MCID) scale or a 12.7-point minimally significant difference (MCD) scale.
- The Quick DASH test is usually used instead of DASH. The patient chooses the answer that is most characteristic of him (1-5 points for each question). Instructions for recording responses are listed below the questionnaire form, but Quick DASH does not have MCIDs studied like DASH does.
- The patient's personal functional scale is a scale in which the patient selects 5 tasks that are difficult to perform and evaluates these tasks from 0 to 10 points, where 0 is inability to perform and 10 is execution. The MCID for an average of 5 tasks is 2, while for one task the MCID is 3 points.
Symptoms
- Pain and tenderness on the inside of the elbow, especially when trying to throw a ball
- Clicking or cracking tear or discomfort during injury
- Swelling and hematomas (after 24 hours) at the site of injury on the inside of the forearm in the elbow area and above if a rupture has occurred.
- Inability to throw with full force, loss of ball control
- Stiffness in the elbow, inability to straighten the elbow
- Numbness or tingling in the fingers
- Impaired hand functions such as grasping and performing small movements.
What is an elbow sprain?
In case of injury, only the ligaments, which are represented by bundles of connective tissue, are usually stretched. Closed damage to one, several or all bundles occurs.
Depending on the severity, sprains are divided into:
- mild – the pain is mild, activity is possible without sharp pain in all directions, diagnostics reveals microscopic tears or sprains;
- medium – partial rupture of the ligament, severe pain, local swelling and hyperthermia are observed (at the site of injury) and there is a limitation in the ability to move depending on the location of the injury;
- severe - complete rupture of the ligament, movement in any direction is impossible due to severe pain.
The elbow joint connects the humerus, ulna and radius. Reliable stabilization is provided by four ligaments: quadrate, annular, ulnar collateral and radial collateral. Incorrect therapy and self-medication can lead to improper fusion of ligaments.
Not only athletes can experience elbow joint injuries. The injury is caused by unusual stress. For example:
- sudden lifting of a large load;
- falling on a straight arm;
- sharp and strong turns of the hand;
- long-term repeated manipulations with flexion/extension of the joint.
Before starting any challenging exercises, you should warm up. And for those who are just starting their journey in sports or fitness, you need to increase the load gradually. Whenever possible, special restraints should be used in work and sports where there is a risk of injury.
Diagnostics
Pain over the medial aspect of the elbow, tenderness directly over the ulnar collateral ligament, and specific functional tests that simulate stress on the ligament may be helpful in diagnosing injury to this ligament. Specific physical tests include a valgus stress test, in which force is applied to the elbow and range of motion is tested. This may be the most sensitive functional test. MRI is the best method for imaging the soft tissues of the elbow joint. Small tears on the lower (deep part) of the ligament are especially well visualized when using contrast (injected into the elbow) as such damage cannot be seen without contrast.
Prevention
Having suffered a sprain once, there is a high probability of repeated injury of this kind. For prevention, injury to the elbow joint should be avoided. You need to choose comfortable shoes and watch your step to avoid falls. If you are into cycling, rollerblading or skateboarding, be sure to wear elbow pads.
A sprain is a fairly serious type of injury. If the elbow joint is treated incorrectly or untimely, pain will accompany any movement of the elbow for years.
Author: Oksana Belokur, doctor, especially for Ortopediya.pro
Treatment
A minor injury may heal on its own.
Conservative treatment is indicated for most patients who manage to return to their usual activities. Conservative treatment includes: the use of NSAIDs (ibuprofen aspirin), analgesics, cold compresses on the injured area, limiting the load on the elbow, wearing a splint, and physical therapy. Surgical treatment is generally required only for a small number of patients with complete ligament rupture or those with persistent pain, hand dysfunction, or risk of ligament rupture. Most often, these patients are baseball players.
Operation Tommy John. Patients with an acute ligament tear, those who have failed conservative treatment, and those who wish to continue playing baseball require surgical reconstruction (repairing the ligament using other tissues). This operation is known as the "Tommy John" operation and is named after the player whose career was successfully saved when the ligament was reconstructed by Dr. Frank Jobe.
Ligament reconstruction can be performed using a variety of patient-derived soft tissue grafts, but is most often performed using the palmaris tendon of the forearm. This is explained by the fact that this tendon provides biomechanical characteristics that are similar to the native ligament, and since there are no consequences from its absence, it is an ideal replacement for the ligament. Some patients do not initially have a palmaris tendon and therefore require alternative grafts for reconstruction, such as leg extensor tendons.
First aid
It often happens that after an injury a person is in a state of passion and does not immediately notice the pain, continuing to move his elbow. This leads to even greater damage to the fibers.
To prevent complications, it is important to know about first aid for sprained elbow ligaments:
- Immobilize the injured limb. After an injury, it is impossible to determine on your own whether it is a sprain, bruise, dislocation or fracture. Therefore, it is better to play it safe and fix your hand in one position with a scarf, stick or splint.
- Apply ice to the damaged area. It will stop bleeding, reduce swelling and pain. The ice compress can be kept for no more than 15 minutes, then a half-hour break is needed. You can take painkillers only if the pain is severe, since during the examination the doctor must understand where the pain is.
- Keep your elbow slightly higher than your body.
- Call an ambulance or go to the hospital yourself.
Complications of treatment
Possible complications of conservative treatment include:
- Inability to return to previous level of sports activities
- Frequent recurrence of symptoms such as inability to throw with full force or distance, pain when throwing, and loss of ball control, especially if sporting activity resumes soon after the injury
- Injury to other structures of the elbow, including the cartilage of the outer part of the elbow; decreased range of motion in the arm, ulnar nerve damage, medial epicondylitis, and sprained wrist flexor tendons.
- Damage to articular cartilage, resulting in the development of elbow arthritis
- Elbow stiffness (decreased range of motion)
- Symptoms of ulnar nerve neuropathy
Possible complications of surgical treatment include:
- Surgical complications not specifically related to this operation, such as pain, bleeding (rare), infections (
Complications characteristic of surgical treatment of this disease:
- Inability to restore normal stability
- Inability to return to previous activity level
- Ulnar nerve injuries
- Irritation of skin areas associated with palmaris tendon graft harvest
Differential diagnosis
- Heterotopic ossification: significant loss of passive range of motion without loss of muscle strength.
- Malignant neoplasms: acute progressive pain not associated with movement.
- Inflammatory arthritis: abnormal systemic signs.
- Fracture: Trauma history, elbow extension test (specificity: 0.69, sensitivity: 0.97), noted limitations in range of motion, and hematoma.
- Dislocation: increased bony prominence, joint effusion, or the appearance of elongation of the forearm, which may affect neurovascular status.
- Inflammatory process: sudden swelling without injury.
- Damage to the vascular system: numbness, tingling, abnormal pulsation.
- Radiating pain from the neck.
- Referring pain from the shoulder.
What are tendons
Visually, the tendon is a bundle of threads. This is the part of the muscle with which it is attached to the bone. Often ordinary people confuse tendons and ligaments, the first of them are located between the muscles and bones, and the second fix the bones in the joint.
Ligaments provide mobility to the joint. The function of tendons, or hamstrings, is to transmit forces from muscles to bones.
Tendons are made up of connective tissue made up of different types of collagen fibers. They come in various shapes and have a specific structure, due to which they have high strength, but have little stretch.
With age, there is a weakening of the tendons, which can even with minor loads lead to tears - that is, partial disruption of the integrity of the tendon bundles. This can occur in both the central and peripheral areas of the tendon.
Treatment of tendon injuries is carried out by a traumatologist, surgeon, or osteopath.
Rehabilitation after injury
Recovery can take from 10-15 days to 3-6 months.
The main goal of all activities is to strengthen the ligaments and maintain their elasticity. In addition to drug treatment, the following types of procedures will be useful:
- massage of muscles and ligaments of the damaged area;
- Exercise therapy - therapeutic exercises;
- physiotherapy - acupuncture, ultrasound, electric current or magnetic radiation, as well as paraffin and ozokerite applications.
Gymnastics can be performed at home as soon as the acute pain passes and the swelling subsides. The main exercises are movements of the limb in the elbow joint (flexion, extension and rotation). Then you can begin to strengthen the ligaments - lean on your hands and gradually transfer weight to them.
Additionally, it is worth taking a course of massage and physiotherapy. These activities will allow you to relax your muscles, improve blood circulation and tissue nutrition. At home, you can gently massage the muscles of the shoulder and forearm, and make paraffin applications. The course is long; in general, rehabilitation may take from 1 to 6 months.
Diagnostic studies for injuries to the articular tissue of the elbow
Elbow on x-ray during diagnosis.
If an injury occurs, the patient must contact a traumatologist for an examination, which includes:
- Collect an oral history of a sprain.
- Counting the pulse, examining the skin for hyperemia or cyanosis. Skin manifestations occur when blood flow is disrupted.
- Assessment of motor activity of the damaged joint.
- Inspect the victim's body for other injuries.
After completing the history taking and palpation of the injured arm, the doctor prescribes a hardware examination:
- X-ray.
- Ultrasonic.
- Computed tomography.
- Magnetic resonance imaging.
Important! Laboratory research methods are carried out when there is serious damage to the joint tissue and the patient is hospitalized. They include taking a general blood test and passing urine for OAM.
Taking blood from a vein during hospitalization of a patient with damage to the fibers of the elbow ligaments.
Ligament restoration
Damage to this element is quite rare and relates more to sports. They can be partial or complete. In the first option, the entire course is treated with conservative methods and lasts for 2-3 weeks. During this period, the patient's limb is immobilized.
Elbow ligament injury
In case of a complete rupture, manipulations to fuse the ligaments are necessary. To do this, an incision is made on the back of the elbow, and the connective tissue is sutured in small sections.