UCL Reconstruction (Tommy John Surgery)
A damage of the ulnar collateral ligament is a trauma which brings a lot of discomfort and soreness. The ulnar collateral ligament is a structure that helps the antebrachium function properly. The damage can be a sudden rupture or a gradual sprain of the UCL. The ulnar collateral ligament helps the cubitus not to twist inward. When a ligament ruptures, as a rule, self-healing does not occur, or as a result of regeneration, the ligament becomes longer. In this case, the patient requires an operational intervention (e.g. reconstruction).
Most traumas of UCL occur when throwing objects overhead. As a rule, repetitive overloading, which ultimately weakens the UCL significantly and ultimately leads to its rupture, may lead to the trauma. Other determinant conditions for Tommy John include:
- Contact sports and also activities in which falls on an outstretched arm occur, often resulting in dislocations;
- Throwing sports;
- Sports where there is arm movement over the head (volleyball and tennis);
- Poor physical condition (weak muscle strength and flexibility).
Symptoms and Causes of a Tommy John
As a rule, patients experience sharp aching in the cubitus joint while throwing. During examination, the doctor often notes a bone crunch during the movement in the UCL. Such symptoms usually indicate the presence of multiple bone growths and intra-articular free bodies around the joint. The patient also feels discomfort and pain in the area of the UCL attachment. In this case, the Tommy John surgery was prescribed quite frequently.
As for radiation diagnostic methods before the Tommy John, MRI imaging is the gold standard in assessing the condition of the cubitus joint, as well as identifying the pathology of the articular cartilage. X-rays also provide a lot of information to the specialist in the initial assessment of the cubitus joint. Osteophytes are especially clearly visible on radiographs.
The stretching of the ulnar collateral ligament inevitably leads to a decrease in its strength and, later, to rupture. Sometimes, with prolonged training, ulnar neuritis with insensibility may be detected as well. Since the nerve runs along the inner (medial) surface of the joint, with repeated throws with the hand, it can also stretch and become inflamed. In case of insufficiency of the UCL, these indicators of speed and accuracy deteriorate significantly.
Treatment of UCL Injuries
Traditional treatment is prescribed to the most patients who manage to return to their usual activities. Such treatment involves the use of NSAIDs (ibuprofen aspirin) analgesics, cold compresses on the injury area, limiting the load on the cubitus, wearing a splint and physiotherapy. Operational treatment such as the Tommy John surgery is normally required for those patients who suffer from a complete rupture of the UCL or dysfunction of the arm.
Patients with a rupture of the UCL, and those who want to continue playing baseball, require the reconstruction (such as the Tommy John surgery). Ineffectiveness of traditional treatment is also one of the key factors in this issue.
The reconstruction can be provided with the soft tissue grafts derived from the patient, but the Tommy John surgery is done using the tendons of the antebrachium muscle in most cases. This is explained by the fact that this tendon has the same biomechanical specifications as the UCL, and since its absence does not affect the body condition, it is an ideal material for reconstruction. Some patients do not initially have the palmaris tendon and therefore require alternative grafts for reconstruction.
Trauma to the ulnar collateral ligament normally does not completely heal with the non-operational methods. It is worth noting that operational treatment is often required. Returning to sports after a trauma can be possible after 12-36 weeks without Tommy John surgery, and in case of an operation – 9-18 months.
The exercise therapy allows you to increase muscle strength and endurance after the Tommy John treatment. Exercises must be selected with an exercise therapy doctor.
Risk and Complications of UCL Reconstruction
A number of issues after the operational treatment of this disease include:
- Decreased range of motion;
- Ulnar nerve trauma;
- Skin irritation.
Some measures can be taken in order to avoid such problems and reconstruction in the future:
- Warm up appropriately prior to training or competition.
- Maintain adequate muscle strength in the antebrachium and wrist.
- Use of appropriate protective techniques for falls and throws.
- Functional orthoses can be effective in preventing injury, especially re-injury, in contact sports.