Elbow Ligament Tears

By Ashley Chrestman, MS, ATC
Athletic Trainer

The Elbow is a hinged joint that is made up of three bones the humerus, the radius, and the ulna. The Elbow joint is a very stable joint that allows for flexion and extension, but very little movement side to side or rotation. The ends of the bones are covered in a cartilage that has a rubbery consistency that allows the joints to slide easily against one another.

The Elbow is made up of four main ligaments.

• The Medial (Ulnar) Collateral ligament is the inside ligament that connects the ulna to the humerus.
• The Lateral (Radial) Collateral Ligament is the outside ligament that connects the radius to the humerus.
• The annular ligament forms a ring around the head of the radius and holds it into place against the ulna.
• The quadrate Ligament also connects the radius to the ulna

The most commonly known Ligament tear in the elbow is the UCL. The UCL is mostly injured from repetitive stress from an overhead throwing motion such as baseball or javelin. The UCL can also be torn from falling on an outstretched hand. This trauma is sometimes associated with an elbow dislocation or a fracture. If a reconstruction surgery is performed on the inner side of the elbow for the ulnar collateral ligament this is known as the famous Tommy John surgery originally performed by Dr. Frank Jobe on the pitcher Tommy John. Tommy John surgery, or UCL reconstruction, replaces the ligament inside the elbow with a tendon from elsewhere in the body. The tendon acts as a new ligament and stabilizes the elbow, reduces or eliminates pain, and allows for range of motion. The replaced tendon is called a graft. It can be harvested from various parts of the body or from a donor, and is typically taken from a forearm tendon called the palmaris longus. Unfortunately, high school baseball pitchers are undergoing this surgery at an alarming rate.

 

Most overuse injuries such as a UCL tear from a high school baseball player could be prevented by taking time off from the sport. According to the pitch smart guidelines by the MLB recommendations are to take off at least 4 months from competitive pitching each year, including at least 2-3 months off from all overhead throwing. Sidearm throwing also adds an increased amount of torque to the elbow. Making sure to develop proper throwing mechanics and developing a consistence fastball and changeup before breaking balls is key point in preventing these overuse injuries. Lastly, setting and following a pitch count can reduce your risk of an overuse UCL injury. The chart below from Pitch smart shows max pitches in a game and day's rest between each pitch count.

Age	Daily Max (Pitches in Game)	0 Days Rest	1 Day Rest	2 Days Rest	3 Days Rest	4 Days Rest
9 to 10	75	1 to 20	21 to 35	36 to 50	51 to 65	66+
11 to 12	85	1 to 20	21 to 35	36 to 50	51 to 65	66+
13 to 14	95	1 to 20	21 to 35	36 to 50	51 to 65	66+
15 to 16	95	1 to 30	31 to 45	46 to 60	61 to 75	76+
17 to 18	105	1 to 30	31 to 45	46 to 60	61 to 75	76+

Pictures: “Elbow Ligament .” 321gomd.Com, Sean Rocket, 19 Aug. 2021, www.321gomd.com. Accessed 19 Oct. 2021.