Baseball Season is Here: Watch Out For UCL Tears

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Spring brings with it the joy of baseball, but too much of a good thing can lead to elbow injuries in young pitchers.

An expert from UT Southwestern in Dallas offers some tips for youth baseball players, their parents and coaches about avoiding and being aware of injuries, including tears or ruptures of the ulnar collateral ligament (UCL).

“Athletes 18 and younger should not pitch more than 100 innings in games during a calendar year,” said Dr. Nathan Boes, an assistant professor of orthopedic surgery at University of Texas Southwestern Medical Center and director of sports medicine for Parkland Memorial Hospital in Dallas. “And they should take four months a year with no competitive pitching.”

UCL injuries are the most common elbow injury among baseball players of all ages, from youth to major leagues. When the injury is severe, it can require reconstructive surgery, sometimes called Tommy John surgery, named after the pitcher who was the first to have the procedure in 1974 while with the Los Angeles Dodgers.

The UCL runs along the inside of the elbow, with three bands that connect the upper arm bone to the largest of the forearm bones. What happens is that pitching’s repetitive motion causes microtrauma in the UCL. Symptoms include a popping sensation, swelling or irritation on the inside of the elbow, pain while throwing and numbness or tingling in the ring and pinky fingers.

“Parents and coaches should avoid youths’ yearlong specialization in only baseball,” Boes said in medical center news release. “Athletes should be encouraged to play multiple sports, to give their arms a break during the offseason.”

Young players ages 15 to 19 now comprise almost 57% of UCL reconstruction surgeries.

It’s best to have your young baseball player checked by an orthopedic or sports medicine doctor if they have elbow pain or trouble throwing, Boes advised. When left untreated, these injuries can lead to nerve damage and stress fractures.

Diagnosis involves a physical exam and an X-ray or MRI. Treatment varies, depending on severity of the injury.

Treatments can be nonsurgical, which includes anti-inflammatory medications, ice and physical therapy. Rehabilitation can take 12 or more weeks.

If that’s not enough, it may require UCL repair or reconstructive surgery.

In repair, ligament tears may be able to be treated through a small incision on the inside edge of the elbow. Patients usually can begin a supervised throwing program in about 10 weeks, Boes said, with a goal of returning to competition about six months after surgery.

In reconstructive surgery, the surgeon rebuilds the ligament by transplanting a tendon, usually from the patient’s wrist. Recovery lasts up to a year. About 90% of patients can return to their previous level of performance.

“There are many factors that go into rehabilitation after an elbow injury,” Boes said. “Therapy can be used to address deficiencies in core and lower extremity strength, motion, balance, and overall mechanics. Athletes should use this rehab time to be making gains in these areas as well, which will enhance their arm recovery.”

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