Ulnar collateral ligament injury in the overhead athlete: Diagnosis and treatment

Abstract

The elbow joint is a complex structure that allows for the transmission of forces from the lower extremity to the ball, racket, or other instrument or object. In many sports, it must withstand tremendous forces that are not often encountered in daily living. Significant valgus force is not common as part of the activities of daily living, as it is in sporting activities. Significant valgus force can be destructive, with medial elbow tensile forces, lateral compressive forces, and posterior shear forces. The ulnar collateral ligament is commonly injured; however, injury may not always be manifest by gross laxity or pain at the ligament. The athlete who has UCL injury may present with symptoms related to secondary overload of other areas about the elbow accentuated by UCL laxity, such as medial epicondylitis, ulnar neuritis, lateral elbow pain due to radiocapitellar overload, posterior elbow pain due to valgus extension overload, or loose bodies. The clinician must maintain a high index of suspicion for any pain about the elbow in the throwing athlete as potentially being due to UCL insufficiency, and must focus on direct management of the underlying problem, not just the symptom, because treating the symptom rarely prevents the symptoms from returning. © 2004 Elsevier Inc. All rights reserved.