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Anchoring the Elbow: The Role of the UCL

Anchoring the Elbow: The Role of the UCL
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All in all, being employed as a professional baseball player is a pretty good gig. While hardly every baseball player is famous, even the team bench warmers are richly compensated for their services. In 2012, the average salary for a professional baseball player was an eye-popping 3.2 million.

The main drawback of such a job (and hefty paycheck) is the risk of injury. Professional athletes place a heavy burden on their bodies, to the point where they buckle under the pressure. Such a scenario recently befell Matt Harvey, a 23-year old pitcher for the New York Mets. Harvey was enjoying an excellent sophomore season in the big leagues until suffering an arm injury in August 2013. What makes Harvey’s injury particularly troubling for Mets fans is that it involves the ulnar collateral ligament (UCL), meaning that it could potentially derail the young Met’s career.

What the UCL Does for the Body

Quick question – how long do you think you could go without moving your elbow? While the answer might vary a bit from person to person, the general consensus would probably be some variant of “not very long.” Whether you’re an athlete or a committed couch potato, a healthy elbow joint is an essential cog in your arm. As with other joints in your body, the elbow joint is linked together by ligaments, flexible bands of tissue that enable the elbow to hinge back and forth.

The UCL is one of these ligaments, positioned on the side of the elbow that faces the torso. Pitchers rely on their UCLs to repeatedly throw a baseball with speed and precision. While such pitching motions can leave opposing batters in the dust, they can also stress the UCL to the point of tearing. All of those 95 mph fastballs can cause small tears to develop in the UCL, tears that can steadily increase in size until the ligament partially (or fully) ruptures.

Grading the Injury

UCL injuries, along with ligament injuries in general, are typically labeled as sprains. In order to provide the patient with a more descriptive diagnosis, doctors classify sprains using a simple grading scale. Grade I sprains only involve very small tears in the UCL, which are also referred to as micro-tears. If the damage is significant enough for the ligament to be partially torn, the sprain receives a grade II diagnosis.

A grade II UCL sprain causes the elbow joint itself to become lose, which compromises the stability of the entire joint. In turn, this ups the burden placed upon the already damaged UCL, and can also affect the other tissues adjacent to the elbow. The most severe form of ligament injury, called grade III strains, occurs when the UCL is torn in two. It is this type of injury that has put countless pitchers on their teams’ disabled list.

Once a patient has sustained a tear, he or she can expect to encounter the following symptoms:

  • Noticeable pain and tenderness at the injury site. Both of these problems are amplified when the patient makes a throwing motion.
  • A clearly audible “pop” sound from the elbow, indicating that the ligament has been partially or completely torn.
  • Swelling in the interior section of the elbow. If the ligament tear has occurred suddenly (as opposed to developing over a prolonged period of time), swelling may also appear in the upper forearm area.
  • The patient is unable to throw objects at normal speed
  • The elbow becomes abnormally stiff and immobile, to the point that the patient is unable to strengthen his or her elbow
  • Feelings of numbness and/or a tingling sensation develop in the afflicted arm’s fingers
  • The damaged arm’s hand is unable to strongly grip objects

Not surprisingly, the severity of these symptoms depends on how badly the UCL has been damaged.

The Story of Tommy John

Most baseball fans have heard the name “Tommy John.” Actually, they are probably more familiar with the surgical phrase that bears his name than the man himself. In 1974, John was a standout pitcher for the Los Angeles Dodgers, putting up excellent numbers for a team that would eventually capture the pennant. During a July contest against the Montreal Expos, John reached back to throw his trademark sinkerball. As the twelve year veteran released the pitch, he felt a sudden swell of severe pain in his left elbow. John’s elbow was so badly hurt during the pitch that the baseball nearly wound up in the stands.

After trying in vain to keep pitching, John was forced to remove himself from the game. John immediately consulted the Dodgers’s team doctor, Frank Jobe. A quick examination of the pitcher’s elbow was all it took for Jobe to make a diagnosis; the 31-year old had sustained a UCL tear. Jobe advised John to follow the then-standard treatment protocol for such an injury, which involved simply resting the elbow and allowing it to heal.

A month later, John’s elbow still had not repaired itself. In fact, the injury had made it all but impossible for John to play his favorite sport. John’s practice pitches couldn’t even reach home plate. The Indiana native was facing a grim prognosis; up to this point, severe elbow tears were usually career-ending injuries for baseball pitchers.

John pondered his post-baseball career options, none of which were exactly appealing. He considered working at friend’s San Francisco jewelry store, or staying involved in baseball as a coach. Alternatively, he could move back to his hometown of Terra Haute, IN, and take a job at another friend’s car dealership. Each option represented a major downgrade for one of baseball’s best pitchers.

What John had that other pitchers didn’t have, however, was the expertise of Dr. Jobe. While treating polio patients, Jobe had learned of a surgical technique that replaced torn elbow ligaments with tendons, bodily tissues that attach muscles to the skeleton. Jobe proposed removing tendons from John’s wrist and inserting them into the damaged elbow. In theory, this could stabilize the injured elbow, potentially allowing John to regain his lost athletic prowess.

Upon hearing the details of the proposed surgery, the Dodger’s ace once again reviewed his options. If he passed on the surgery, his chances of making a return to pitching were virtually zero. On the other hand, Jobe could only promise a 1 percent chance that the procedure would allow John to pitch again. Reasoning that a 1 percent chance beat a 0 percent chance hands down, John decided to go ahead with the experimental surgery.

A quick glance at John’s post-1974 career stats confirms that John made the right decision. After returning to pitching during the 1976 season, John would go on to win an additional 164 games before retiring in 1989. Instead of being forced into early retirement, John would continue pitching until the ripe old age of 46. Dr. Jobe’s shot-in-the-dark would eventually become known as Tommy John’s surgery, a procedure that has extended the shelf life of numerous players. Of all the pitchers currently on major league rosters, more than 10 percent have undergone Tommy John’s surgery at some point in their careers.

Other Forms of Treatment

Unless you pitch for a professional baseball team, you probably won’t need to undergo Tommy John’s surgery to heal a sprained UCL. For non athletes, doctors will usually recommend the RICE treatment protocol, which consists of the following four steps.

Resting the injured body part

Icing the injury for 15 to 20 minutes several times per day

Compressing the sprain with an elastic bandages or other materials

Elevating the sprained body part above heart level

Most patients who strictly adhere to the preceding steps find that their symptoms gradually dissipate. To aid the recover process, doctors will likely advise the patient to use nonsteroidal anti-inflammatory drugs, or NSAIDs for short. These medications can be purchased at drug stores without a prescription.

Like all ligaments, sprains impacting the UCL can easily disrupt the body’s routine operations. Fortunately, a banged-up UCL is (usually) not a threat to your long-term health. While Tommy John’s surgery offers a practical surgical solution to those that need it, most patients can make a full recovery without going under the knife.

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