UCL Tear (Ulnar Collatera Ligament / Tommy John)
The ulnar collateral ligament is often injured in baseball pitchers, and can be the result of one traumatic injury, or repeated stress over time. Sometimes, the athlete may even hear a pop, which is followed by bruising and swelling on the inner aspect of the elbow. Numbness and tingling in the 4th and 5th fingers is not uncommon.
There are several specialized tests that can be done in the office if a UCL injury is suspected. Plain x-rays can occasionally show a small fracture, and an MRI is often done to better evaluate the ligament. If the studies are inconclusive, a dynamic ultrasound can be done to determine whether there is significant laxity (looseness) in the elbow.
Treatment of complete UCL tears in baseball pitchers often involves a ligament reconstruction, where a tendon is taken from the athlete or from a cadaver and used to recreate the torn ligament. Partial tears, as well as complete tears in non-baseball pitchers, can often be treated with a directed rehabilitation program.