Tarheel Health Portal/Ulnar Collateral Ligament Injury Prevention

The Ulnar Collateral Ligament (UCL), or medial collateral ligament of the elbow joint is part of the human elbow joint and, connects the  humerus to the  ulna. Repetitive stressful motions, such as throwing a baseball, can cause the ulnar collateral ligament to become stretched, frayed or torn. When the tendon is torn doctors can perform ulnar collateral ligament reconstruction or Tommy John Surgery to replacing the ligament with a graft from somewhere else in the body. After the surgery, and a ten to twelve month rehabilitation process, an estimated 85 to 90 percent of patients are able to make a full recovery and return to their same level of pre-injury performance. This outstanding success rate for the surgery has allowed pitchers to return at such a high level of play that it is now not uncommon to see pitchers tear their UCL a second time. Studies have shown that to prevent the injury from occurring players should be limited in their number of throws during adolescence in order to prevent injury later in life. The University of North Carolina Chapel Hill has an Exercise and Sports Science Research lab dedicated to studying UCL injuries.

Relevance
Ulnar Collateral Ligament tears have become a common place in the game of baseball. Young stars such as Matt Harvey,  Zack Wheeler,  Stephen Strasburg,  José Fernández,  Yu Darvish, and  Masahiro Tanaka,  all had UCL tears early in their careers. It has gotten to the point that it is now more surprising when a young pitcher does not get injured. The high success rate of UCL reconstruction surgery, 85 to 90% return to perjury level of competition, has led many people around baseball to believe that the surgery is only a minor set back with no long term consequences. This is a dangerous assumption do to the potential of re-injury to the elbow later on and the velocity loss many pitchers suffer. Brian Wilson, Kris Medlen,  Brandon Beachy,  Josh Johnson, and  Jarrod Parker are all pitchers who re-tore their UCL a second time. When a player requires surgery both the player and the club loses money. For players the injury is a major red flag that they must prove they can overcome and something that could hinder them from receiving a long term contract. Loosing quality young pitchers for an entire season at a time can set back baseball teams for years costing them untold amounts of money in ticket and jersey sales.

Causes of UCL Tears
For years it was thought that Ulnar Collateral Ligament tears occurred as a result of players throwing curveballs before their growth plates had closed causing them to put too much stress on their arm at too young of an age. Another widely accepted view was that the injury occurred because the player had poor throwing form that put unwanted stress on their arm. Well renown Doctors James Andrews and  Glenn Fleisig have preformed multiple studies and shown that the injury is instead more closely linked to the amount of pitches the player throws during their adolescent years. Studies show a significantly higher number of pitches per game and per year in players who hurt there elbows then in their counter parts who do not suffer an injury. The pressure of players to specialize in a certain sport at a young age causes young baseball players to put their arms through more stress then ever before. Coaches and parents often put their children at risk by over playing them instead of focusing on their long term health and playing career. As a result many players acquired by major league teams and colleges are already at a high predisposition to injury before they step on the mound for their new team.

Prevention
In order to obtain a more quantitative way to predict arm injuries a study published in The American Journal of Sports Medicine tested the shoulder range of motion in high school baseball and softball players. They determined in their results that players who had 10 to 20 degree decreases in shoulder range of motion between their dominant (throwing) shoulder and their non-dominant shoulder had a 1.5 to 2 times greater chance of injury. In order to lower UCL injury rates in the future I propose that all parents of little league players be educated on safe pitch count restrictions for their children and appropriate rest time for arm recovery. I would also educate parents on the long-term consequences of injury to players’ arms if the protocol is not followed and the costs of surgery. I would suggest high schools mandate range of motion testing for high school baseball players, just as football players have regulated concussion testing and wrestlers have mandatory body fat testing. Trainers could identify players who failed the test and put them in proper programs to rehab their arms. I would also encourage baseball organizations, other than Little League baseball, to adopt pitching limits for players in order to keep coaches from overusing the arms of their most talented players. With these in effect we would be able to prevent a future generation from continuing the increasing trend of elbow injuries that is plaguing baseball's best young pitchers. This would include future North Carolina athletes who are often top level players coming out of high school.

Further Readings
[ESPN: Tommy John Epedimic?]

[List of Players to have Tommy John Surgery]

[Dr. Glenn Fleisig Bio]