by Michael Regan
Intro
The elbow is a hinge joint composed of three bones, the humerus, ulna, and radius, ligaments, tendons, and muscles that work together to allow overhead throwing. In baseball, especially during pitching, the elbow is subjected to extreme shear forces as the arm accelerates perpendicular to the hinge of the joint. This places most of the force on the soft tissue structures on the inside of the elbow. These structures include the flexor muscles of the forearm, along with the infamous UCL ligament. Every pitch can create twice as much force as the UCL can handle on its own, meaning the muscles of the arm have to be strong in order to absorb that force and keep the UCL in tact.
The Lead Up
Before baseball players injure their UCL, there are often warning signs. Some of the most obvious signs are chronic pain and soreness, heaviness, pins and needles/numbness down to the hand, or weakness while throwing. As athletes try to throw through discomfort, it often leads to a higher likelihood of injury happening.
Post Injury/Surgery
If a UCL injury is suspected, an athlete should be referred to an orthopedic surgeon that specializes in elbows and performing UCL surgery. Often times these doctors are board certified in sports medicine and do a fellowship specializing in the shoulder and arm. UCL injuries are confirmed by MRI imaging of the elbow which will show the tear. There are two main surgical options: a reconstruction and a repair. The majority of all UCL injuries qualify for a reconstruction surgery which is the standard procedure in which they build a new ligament to replace the UCL. The repair option is a more recent development where, in specific cases, they can bridge the two ends of the existing ligament back together and put an internal bracing support in to support the elbow as the existing ligament has time to heal.
Rehabilitation
The rehab process is unfortunately on the longer side in terms of sports injuries. Typically, it takes 12-15 months from surgery to return to throwing. Early on, the rehab process will focus on protecting the ligament, restoring simple motion, and beginning light isometric strengthening. As the ligament strengthens, the focus will become more involved strength training and restoring full ranges of motion. Much like picking the right surgeon, it is important to pick a therapist that has experience with UCL rehab as they will be able to tailor the best program possible for the individual athlete.
Return to Throw
Once the surgeon clears an athlete to begin to throw, it is important to stick to the plan put into place by the therapist. This will allow force to gradually be applied and the muscles and ligament to strengthen and grow. Over time, distance, volume, and intensity will increase, building back to a full workload. It is highly recommended that any pitching coaches or team coaches are put into contact with the therapist so an open line of communication can be established, and everyone is on the same page working towards the same goal.
