UCL Repair For Baseball Players

Any baseball player knows how important it is to stay healthy and injury-free while playing, but sometimes injuries are unavoidable. One common injury for pitchers and overhead-throwing athletes that can happen over time is a partial or complete tear of the ulnar collateral ligament (UCL) in your elbow. You have multiple treatment options, but whichever you choose, you should be back on the field with enough recovery time. A physical therapist can be a great specialist to help with that. Our team at EW Motion Therapy can create an individualized, sport-specific treatment plan for you to help build strength and improve mechanics in your throwing arm to get you back in the game. Even if you decide our services do not fit your needs, you can still read on for our discussion of how UCL tears happen, how they affect baseball players, current treatment options and surgical interventions, and how physical therapy can help. 

If your arm hurts while throwing a baseball, it could point to a deeper injury. Learn more about improving throwing techniques here.

What is the UCL, and how can it be torn? 

The UCL is a complex of 3 bands of tissue on the elbow joint’s inner side. It connects the upper arm’s humerus bone to the forearm’s ulna bone and plays a crucial role in stabilizing the elbow joint during throwing motions. You can injure the ligament through overuse or trauma, such as falling on an outstretched arm.

A torn UCL can cause a range of symptoms, including:

1. Pain on the inner side of the elbow: This is the most common symptom of a UCL tear. The pain may be sudden and severe or develop gradually over time.
2. Swelling: The elbow may become swollen and tender to the touch.
3. Stiffness: The elbow may feel stiff or restricted in movement, especially when attempting to extend the arm.
4. Weakness: The affected arm may feel weak and unstable, making throwing or gripping objects difficult. You may also feel a popping sensation while throwing.
5. Numbness or tingling: Some individuals may experience numbness or tingling in the fingers, hand, or forearm.

UCL injuries are typically graded based on the severity of the tear. There are three grades of UCL injury: 

1. Grade 1: This is a mild injury in which the ligament is stretched but not torn. Symptoms may include mild pain, swelling, and stiffness, but the individual can typically continue playing.
2. Grade 2: This is a partial tear in which the ligament is partially torn. Symptoms may include moderate pain, swelling, and stiffness, and the individual may have difficulty throwing or gripping objects.
3. Grade 3: This is a complete tear in which the ligament is fully torn. Symptoms may include severe pain, swelling, and instability in the elbow joint, making throwing or performing daily activities difficult. Surgery is usually necessary to repair a grade 3 UCL tear.

How does a UCL tear affect baseball players? 

Baseball players, especially pitchers, rely heavily on their UCL to stabilize the high-velocity throws necessary for the sport. During the throwing motion, the UCL is placed under significant stress as the arm is cocked back and then rapidly whipped forward, generating forces that can reach up to 100 pounds per square inch. The UCL helps absorb these forces, keeping the elbow joint stable and preventing excessive strain on the surrounding muscles and tendons.

Repeated straining from overuse of the UCL can lead to micro-tears in the ligament, eventually progressing to a complete tear. A torn UCL can result in pain, weakness, and reduced mobility in the elbow joint, making it difficult for baseball players to perform at their highest level. In some cases, surgery may be necessary to reconstruct the damaged UCL and restore full function to the elbow joint.

What are your options for UCL repair?

There are four different types of surgeries for repairing the UCL. Let’s review the procedure of each surgery and the recovery time. 

Tommy John surgery

Tommy John surgery is another term for UCL reconstruction surgery, which has become increasingly common among baseball players, especially pitchers. This surgery was first performed in 1974 by Dr. Frank Jobe on Tommy John, a pitcher for the Los Angeles Dodgers, and since then, it has become a go-to procedure for players with a torn UCL. 

In most cases, Tommy John surgery is recommended for players with a severe UCL tear. During the procedure, the surgeon will make a small incision in the patient's elbow and locate the torn UCL. They will then remove the damaged ligament tissue and prepare the bone for reconstruction. To reconstruct the UCL, the surgeon typically uses a graft from another part of the patient's body, such as the wrist, hamstring, or forearm. The graft will be harvested and prepared to fit the specific size and shape of the patient's UCL. The surgeon will then drill small holes into the bone where the UCL attaches and insert anchors or screws to secure the graft. Using sutures, the graft will be attached to the bone, creating a new connection between the ligament and bone. After the surgery, the patient typically wears a splint or brace to protect the elbow and allow the UCL to heal appropriately. Your doctor will also prescribe physical therapy and rehabilitation exercises to help regain the range of motion and strength.

The recovery time for Tommy John surgery is longer than that of primary repair or docking techniques, with most patients needing at least a year to fully recover and regain their previous level of function. The surgery has a high success rate, and most players can return to the field within 12-18 months after the procedure.

Internal brace surgery 

Internal brace surgery is a relatively new type of UCL repair that has gained popularity in recent years. This procedure involves using a small, flexible ligament-like device called an internal brace to reinforce the damaged UCL. The internal brace acts as a scaffold that allows the body to heal the torn ligament while providing stability to the elbow joint during the healing process.

During the surgery, the surgeon will make a small incision in the patient's elbow and locate the torn UCL. They will then prepare the bone and ligament tissue for the internal brace by removing any damaged tissue or debris. Once the area is clean and prepared, the surgeon will insert the internal brace, made of a high-strength, low-stretch synthetic material, through small tunnels drilled in the bone on either side of the UCL. The internal brace is then anchored securely to the bone using small screws or anchors. Once the internal brace is in place, the surgeon will use sutures to reattach any remaining UCL tissue to the bone. The internal brace will reinforce the UCL as it heals, providing additional stability to the elbow joint.

Recovery time for internal brace surgery is typically faster than with other types of UCL repairs, as the procedure is less invasive and the internal brace allows for early mobilization and rehabilitation. Patients may be able to begin range-of-motion exercises and physical therapy within a few weeks of surgery. They can often return to their normal activities within a few months. However, not all UCL injuries are suitable for this type of surgery, and patients should discuss their options with their surgeon to determine the best course of treatment for their individual needs.

Primary UCL surgery 

Primary repair surgery is a type of UCL repair used for partial UCL tears or when the ligament has completely torn off the bone but still has a small piece of tissue attached. During primary repair surgery, the surgeon will reattach the torn ligament to the bone using sutures or anchors. The surgery is typically performed using arthroscopic techniques, which involve making small incisions in the skin and inserting a tiny camera and surgical instruments through the incisions to access the elbow joint. This minimally invasive approach can reduce pain, scarring, and recovery time compared to traditional open surgery.

Once the surgeon has accessed the elbow joint, they will examine the UCL to determine the extent of the damage. If the ligament is partially torn, the surgeon may be able to repair it using sutures to reconnect the torn ends. If the ligament is completely torn off the bone, the surgeon will prepare the bone and ligament tissue for repair by removing any damaged tissue or debris. The surgeon will then drill small holes into the bone where the UCL attaches and insert anchors or screws to secure the ligament back to the bone. The surgeon will also use sutures to connect any remaining UCL tissue to the bone, further stabilizing the elbow joint.

After the surgery, the patient typically wears a splint or brace to protect the elbow and allow the UCL to heal appropriately. The recovery time for primary repair surgery varies depending on the extent of the injury, but most patients can expect to return to normal activities within four to six months. However, the UCL may take up to a year to fully heal and regain its original strength.

Docking technique 

The docking technique is a type of UCL repair similar to primary repair surgery, but with some variations in the surgical approach. It is used for UCL injuries involving a complete ligament tear from the bone and a small tissue fragment still attached.

First, the surgeon will make a small incision in the patient's elbow and locate the torn UCL. They will then prepare the bone and ligament tissue for repair by removing any damaged tissue or debris. Once the area is clean and prepared, the surgeon will fold the torn UCL over itself and attach it to the bone using sutures or anchors. The folded ligament will create a "docking" site for the remaining tissue, which will then be reattached to the bone using additional sutures or anchors. This technique helps to create a more stable connection between the ligament and bone, improving the overall strength and stability of the joint.

Like primary repair surgery, the docking technique can be performed using arthroscopic techniques, which are minimally invasive and can reduce pain, scarring, and recovery time compared to traditional open surgery. After the procedure, the patient typically wears a splint or brace to allow the UCL to heal correctly. The recovery time for the docking technique is similar to that of primary repair surgery, with most patients able to return to normal activities within four to six months. However, the UCL may take up to a year to fully heal and regain its original strength.

How can physical therapy help with recovery and returning to sport? 

Physical therapy after UCL surgery typically involves a gradual and progressive rehabilitation program. This program includes exercises that target the elbow, shoulder, and wrist, as well as overall conditioning to improve cardiovascular fitness and endurance. The rehabilitation program is individualized based on the player's specific needs and goals, and it usually takes several months to complete.

One of the main goals of physical therapy after surgery is to restore full range of motion in the elbow joint. Physical therapists use various techniques, including stretching, manual therapy, and exercises, to help players achieve this goal. Strengthening exercises are also essential in rehabilitation, as they help players regain the strength they lost due to the injury and surgery.

Another critical aspect of physical therapy is the prevention of future injuries. Physical therapists work with players to identify and correct biomechanical issues that may have contributed to the UCL tear. They also teach players proper throwing techniques and guide how to return to the sport after surgery safely. 

Any injury can devastate a baseball player, but you can rest, heal, and return to the field stronger with the proper care team. A physical therapist is an essential member of your care team - our team at EW Motion Therapy considers this a privilege for any athlete we get to rehabilitate. If you’re curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently-asked physical therapy questions.