Dr. Greene discusses “UCL TEARS” (Tommy John Procedure)

ShoreOrtho Sports Performance
& Injury Prevention Tips

A monthly
presented by:
Damon A. Greene, MD
Board Certified Orthopaedic Surgeon
Shore Orthopaedic University Associates

March 2020

UCL TEARS (Tommy John Procedure)

Baseball season is right around the corner. So let’s take a few minutes and talk UCL (Ulnar Collateral Ligament) injuries.

UCL injuries are very common for throwing athletes and those that use their upper extremity frequently. There are two types of injuries acute and chronic. An acute injury can occur if too much stress is put on the elbow in one single incident which can cause the ligament to tear. A chronic injury typically occurs from repeated stress on the ligament. This causes the ligament to be stretched, frayed or torn.  The repetitive motion of throwing can cause small micro tears in the ligament which can result in rupture of the ligament. While everyone’s symptoms are different, patients who sustain a UCL injury will experience elbow pain, numbness, and swelling. Elbow instability will also occur. Some patients suffering from an elbow ligament injury may have trouble gripping items with their hands. Athletes will experience a loss of control with throwing and will not be able to complete a throw at full speed or strength. With an acute UCL injury there is typically a pop or tearing sound.

Injuries to the UCL are often classified as sprains. There are three grades of sprain:

  • A first-degree sprain occurs when the ligament is strained without it becoming stretched. This strain leads to elbow pain.
  • A second-degree sprain occurs when the ligament is stretched. While the patient will experience increased pain, especially with movement, the elbow can still function.
  • third-degree sprain occurs when the ligament has been torn or ruptured. An ulnar collateral ligament tear results in an elbow that loses function all together.

A mild ulnar collateral ligament injury will often resolve on its own with conservative treatment. This includes rest, ice, non-steroidal anti-inflammatory medication. Additionally, physical therapy may be utilized to strengthen surrounding muscles and improve throwing mechanics.

In athletes, patients who have acute trauma associated with an ulnar collateral ligament tear there are many options. Depending on the type and chronicity of the tear a UCL repair with internal bracing can preformed on a reconstruction with a graft known as a “ Tommy John Procedure”.

This surgical technique can use the patient’s own tissue or an allograft to reconstruct the ligament.

Following ulnar collateral ligament surgery, patients are required to wear a brace for approximately 6 weeks, after which moderate exercises and movements of the arm can occur. Physical therapy will be a progressive process that will initially focus on range of motion, and later, strengthening exercises. Most patients are able to return to their sporting activities in roughly 4-6 months following surgery. Throwing at a competitive level may take over a full year for maximal recovery.

Dr. Greene is a Sports Medicine Fellowship-Trained, Board Certified Orthopaedic Surgeon.
He specializes in; acute and chronic ligament, tendon, or cartilage injuries to all major joints; primarily shoulders, elbows, knees and hips. He treats fractures surgically when necessary, but performs casting, bracing, and other non-operative treatments such as specialized injection therapies.


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