Surgeons Sound Alarm: Elbow Ligament Injuries on Rise.
Recent studies suggest injuries to the ulnar collateral ligament (UCL) in the elbow are rising, particularly among teenage baseball athletes 15-19 years old, and elbow doctors and orthopedic surgeons, like noted hand-and-upper-limb-specialist Alejandro Badia MD, are sounding an alarm. They blame the increase on continued participation in year-round sports programs, heightened competitiveness, insufficient injury-prevention programs, and failure to teach proper body mechanics.
Even more concerning, the documented success of ‘Tommy John’ surgery as the gold standard for reconstructing a ruptured elbow UCL in adults is often not appropriate for treating less severe UCL injuries in children, including those whose bones are still growing and developing.”
“Yet, we have no long-term research showing what conservative, nonoperative approaches to UCL injuries can help young athletes maintain healthy, functional elbows now and in the future, especially if they intend moving on to professional sports careers,” says Dr. Badia, founder and chief medical officer of the Florida-based Badia Hand to Shoulder Center and OrthoNOW® and author of the new book Healthcare From The Trenches.
In a study published in the Journal of the American Academy of Orthopaedic Surgeons, authors write that “the intensity of training and competition among young athletes can place them at increased risk of acute and chronic [musculoskeletal] injuries, which occur in patterns unique to the skeletally immature athlete. Prompt recognition and treatment of these injuries are critical to prevent long-term functional disability and deformity.”
Dr. Badia also cites results of an American Orthopaedic Society for Sports Medicine survey of high-school baseball coaches, players, and their parents. In that survey, a significant percentage of respondents indicate being under the misguided belief that the number of balls thrown at high velocity by a pitcher is not associated with greater risk of UCL elbow damage. Some even suggest “Tommy John” surgery might be a welcome procedure because they think it improves a pitcher’s velocity and command.
The UCL is a system of three fibrous tissue bands on the inside of the elbow.
One end of the band is connected to the upper-arm bone (humerus) and the other to the ulna on the “pinky” side of the forearm. The UCL complex plays a critical role in stabilizing the elbow joint, which is formed by the intersection of the humerus, the ulna, and a second forearm bone, the radius (on the thumb side).
Although a traumatic blow to the elbow or a fall on an outstretched arm can rupture the UCL, repeated stress on the elbow from overhead activities, such as throwing a baseball, spiking a volleyball or serving in tennis, is what usually causes the UCL to deteriorate over time, gradually fraying and tearing. In fact, a biomechanical analysis done of professional baseball pitchers and reported in 2016 finds the torque and force of a thrown ball on the elbow and shoulder “are equivalent to five 12-pound bowling balls pulling down on [a person’s] arm.”
Symptoms of a partial or fully torn UCL include pain – sometimes intense pain — on the inside of the elbow when throwing, pain when accelerating the arm forward, and numbness or a tingling sensation in the “pinky” and ring fingers.
The injury, however, does not normally interfere with other activities, including lifting, explains Dr. Badia. “Tommy John” surgery – named after the professional pitcher on whom the technique was pioneered in 1974 – is performed as the reconstructive method of choice for a completely torn elbow UCL, according to Dr. Badia.
“The procedure involves taking a ligament from elsewhere in a patient’s body and then grafting it onto the elbow joint as a UCL replacement. The surgery is normally conducted in an outpatient setting and takes about an hour to 90 minutes to complete. The patient can go home the same day.”
While experienced orthopedic surgeons are generally agreed on the optimal surgical approach to a ruptured UCL, Dr. Badia says a member survey taken several years ago by the American Shoulder and Elbow Surgeons (ASES) shows “lack of consensus” regarding non-surgical management of partial UCL tears and ligament strains, particularly in children, adolescents, and athletes who are not professionals. One approach gaining some traction has been injection of a patient’s own platelet-rich plasma (PRP). In the ASES survey, more than a third of respondents said they use PRP for some UCL injuries.
However, the jury remains out on the effectiveness of PRP, mesenchymal stem cells, and other orthobiologics, Dr. Badia says. For example, a study in the American Journal of Orthopedics concludes that “PRP injections may be particularly beneficial in young athletes who have sustained acute damage to an isolated part of the [UCLM] ligament and in athletes unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.”
The ideal solution, of course, is to prevent UCL injuries in the first place, Dr. Badia says. He offers the following tips to athletes, coaches, trainers, and parents of young athletes:
- Offer weekly strength and stretching exercise programs. Studies indicate such programs can cut incidence of UCL elbow injury by as much as 50 percent.
- Provide continuing education for athletic trainers and coaches on proper preparation of athletes and ways to limit overhead throwing stress on elbows and shoulders.
- Teach athletes proper body mechanics – whether they involve throwing a baseball, serving a tennis ball, or engaging in other repetitive overhead activities.
- Follow safety rules for each sport and avoid participation when fatigued. Research indicates fatigue plays a major role in UCL injuries.
- Cross-train young athletes so that they are not doing the same thing – and putting the same type of mechanical stress on joints – year-round.
- Ensure coaches are limiting the number of pitches, and types of pitches, a young athlete throws in a game and that sufficient recovery days are adhered for resting the thrower’s elbow.
- Be sure to be evaluated by an orthopedist particularly experienced in elbow issues
Finally, “should you, or your athletic son or daughter, develop elbow pain, especially when performing an overhead activity in your sport, do not ignore it. Contact an orthopedic specialist immediately to avoid further damage to the joint,” Dr. Badia advises.
Bio: Alejandro Badia, MD, FACS, is an internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a network of walk-in orthopedic centers. Dr. Badia is the author of Healthcare from the Trenches.