Skip to main content

Abstract

Medial elbow pain in throwing athletes can be debilitating. While the elbow UCL is the most common cause of the pain, it is important for treating physicians to have a good understanding of the extensive differential diagnosis of medial elbow pain in throwing athletes. A full-thickness tear of the UCL in athletes wanting to continue playing baseball typically requires reconstruction. Rehabilitation after UCL reconstruction can be an arduous endeavor that requires commitment from the patient, physician, and training staff. Good to excellent outcomes following reconstruction can be expected, but such an injury can be career altering. As opposed to full-thickness tears, partial tears can often be managed conservatively with a structured physical therapy program and gradual return to an interval throwing program. Some recent studies have highlighted the potential benefits of biologic injections to augment conservative management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kim NR, Moon SG, Park JY, Choi JW, Oh KS. Stress ultrasound in baseball players with ulnar collateral ligament injuries: additional value for predicting rehabilitation outcome. J Shoulder Elb Surg. 2017;26(5):815–23. https://doi.org/10.1016/j.jse.2016.12.075.

    Article  CAS  Google Scholar 

  2. Smith W, Hackel JG, Goitz HT, Bouffard JA, Nelson AM. Utilization of sonography and a stress device in the assessment of partial tears of the ulnar collateral ligament in throwers. Int J Sports Phys Ther. 2011;6(1):45–50. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3105368&tool=pmcentrez&rendertype=abstract.

    PubMed  PubMed Central  Google Scholar 

  3. Saper M, Pearce S, Shung J, Zondervan R, Ostrander R, Andrews JR. Outcomes and return to sport after revision anterior cruciate ligament reconstruction in adolescent athletes. Orthop J Sport Med. 2018;6(4) https://doi.org/10.1177/2325967118764884.

    Article  Google Scholar 

  4. Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in medial ulnar collateral ligament reconstruction in the United States: a retrospective review of a large private-payer database from 2007 to 2011. Am J Sports Med. 2015;43(7):1770–4. https://doi.org/10.1177/0363546515580304.

    Article  PubMed  Google Scholar 

  5. O’Brien DF, O’Hagan T, Stewart R, et al. Outcomes for ulnar collateral ligament reconstruction: a retrospective review using the KJOC assessment score with two-year follow-up in an overhead throwing population. J Shoulder Elb Surg. 2015;24(6):934–40. https://doi.org/10.1016/j.jse.2015.01.020.

    Article  Google Scholar 

  6. Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926–32. https://doi.org/10.1177/0363546506290988.

    Article  PubMed  Google Scholar 

  7. Erickson BJ, Harris JD, Chalmers PN, et al. Ulnar collateral ligament reconstruction: anatomy, indications, techniques, and outcomes. Sports Health. 2015;7(6):511–7. https://doi.org/10.1177/1941738115607208.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cain EL, Mathis TP. Ulnar collateral ligament reconstruction: current philosophy in 2016. Am J Orthop (Belle Mead NJ). 2016;45(7):E534–40.

    Google Scholar 

  9. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg. 1986;68(8):1158–63. https://doi.org/10.2106/00004623-198668080-00004.

    Article  CAS  PubMed  Google Scholar 

  10. Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28(1):16–23. https://doi.org/10.1177/03635465000280011401.

    Article  CAS  PubMed  Google Scholar 

  11. Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30(4):541–8. https://doi.org/10.1177/03635465020300041401.

    Article  PubMed  Google Scholar 

  12. Watson JN, McQueen P, Hutchinson MR. A systematic review of ulnar collateral ligament reconstruction techniques. Am J Sports Med. 2014;42(10):2510–6. https://doi.org/10.1177/0363546513509051.

    Article  PubMed  Google Scholar 

  13. Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34. https://doi.org/10.1177/0363546510378100.

    Article  PubMed  Google Scholar 

  14. Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. Ulster Med J. 2001;70(1):22–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Erickson BJ, Chalmers PN, Dugas JR, et al. Do Major League Baseball team physicians harvest the semitendinosus from the drive leg or landing leg when performing ulnar collateral ligament reconstruction on elite baseball pitchers? Orthop J Sport Med. 2017;5(7) https://doi.org/10.1177/2325967117713987.

    Article  Google Scholar 

  16. Erickson BJ, Zaferiou A, Chalmers PN, et al. Are the hamstrings from the drive leg or landing leg more active in baseball pitchers? An electromyographic study. J Shoulder Elb Surg. 2017;26(11):2010–6. https://doi.org/10.1016/j.jse.2017.06.041.

    Article  Google Scholar 

  17. Osbahr DC, Cain EL, Raines BT, Fortenbaugh D, Dugas JR, Andrews JR. Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: minimum 10-year follow-up. Am J Sports Med. 2014;42(6):1333–42. https://doi.org/10.1177/0363546514528870.

    Article  PubMed  Google Scholar 

  18. Jones KJ, Dines JS, Rebolledo BJ, et al. Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2014;42:117–21. https://doi.org/10.1177/0363546513507695.

    Article  PubMed  Google Scholar 

  19. Jones CM, Beason DP, Dugas JR. Ulnar collateral ligament reconstruction versus repair with internal bracing: comparison of cyclic fatigue mechanics. Orthop J Sport Med. 2018;6(2) https://doi.org/10.1177/2325967118755991.

    Article  Google Scholar 

  20. Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE. Biomechanical comparison of ulnar collateral ligament repair with internal bracing versus modified Jobe reconstruction. Am J Sports Med. 2016;44(3):735–41. https://doi.org/10.1177/0363546515620390.

    Article  PubMed  Google Scholar 

  21. Norwood LA, Shook JA, Andrews JR. Acute medial elbow ruptures. Am J Sports Med. 1981;9(1):16–9. https://doi.org/10.1177/036354658100900103.

    Article  CAS  PubMed  Google Scholar 

  22. Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg. 1992;74(1):67–83. https://doi.org/10.2106/00004623-199274010-00009.

    Article  CAS  PubMed  Google Scholar 

  23. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23(4):407–13. https://doi.org/10.1177/036354659502300406.

    Article  CAS  PubMed  Google Scholar 

  24. Redler LH, Degen RM, McDonald LS, Altchek DW, Dines JS. Elbow ulnar collateral ligament injuries in athletes: can we improve our outcomes. World J Orthop. 2016;7(4):229. https://doi.org/10.5312/wjo.v7.i4.229.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wilk KE, Yenchak AJ, Arrigo CA, Andrews JR. The advanced throwers ten exercise program: a new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Phys Sportsmed. 2011;39(4):90–7. https://doi.org/10.3810/psm.2011.11.1943.

    Article  PubMed  Google Scholar 

  26. Jack RA, Burn MB, Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Performance and return to sport after Tommy John surgery among Major League Baseball position players. Am J Sports Med. 2018;46(7):1720–6. https://doi.org/10.1177/0363546518762397.

    Article  PubMed  Google Scholar 

  27. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003;31(4):621–35. https://doi.org/10.1177/03635465030310042601.

    Article  PubMed  Google Scholar 

  28. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Return-to-play outcomes in professional baseball players after medial ulnar collateral ligament injuries. Am J Sports Med. 2016;44(3):723–8. https://doi.org/10.1177/0363546515621756.

    Article  PubMed  Google Scholar 

  29. Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689–94. https://doi.org/10.1177/0363546513487979.

    Article  PubMed  Google Scholar 

  30. Dines JS, Williams PN, ElAttrache N, et al. Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop (Belle Mead NJ). 2016;45(5):296–300.

    Google Scholar 

  31. Clark NJ, Desai VS, Dines JD, Morrey ME, Camp CL. Nonreconstruction options for treating medial ulnar collateral ligament injuries of the elbow in overhead athletes. Curr Rev Musculoskelet Med. 2018;11(1):48–54. https://doi.org/10.1007/s12178-018-9458-3.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Frangiamore SJ, Lynch TS, Vaughn MD, et al. Magnetic resonance imaging predictors of failure in the nonoperative management of ulnar collateral ligament injuries in professional baseball pitchers. Am J Sports Med. 2017;45:1783–9. https://doi.org/10.1177/0363546517699832.

    Article  PubMed  Google Scholar 

  33. Deal JB, Smith E, Heard W, O’Brien MJ, Savoie FH. Platelet-rich plasma for primary treatment of partial ulnar collateral ligament tears: MRI correlation with results. Orthop J Sport Med. 2017;5(11) https://doi.org/10.1177/2325967117738238.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Carr, J.B., Dines, J.S. (2019). Elbow Pain in a Throwing Athlete. In: Kibler, W., Sciascia, A. (eds) Mechanics, Pathomechanics and Injury in the Overhead Athlete. Springer, Cham. https://doi.org/10.1007/978-3-030-12775-6_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-12775-6_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12774-9

  • Online ISBN: 978-3-030-12775-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics