Ulnar Collateral Ligament Tears: Evaluation and Nonsurgical Management

The medial ulnar collateral ligament of the elbow is the primary stabilizer against valgus load. It can tear acutely or through attritional damage as in repetitive overhead sports. Although baseball players, particularly pitchers, are the most vulnerable athletes, these injuries also occur in contact athletes, gymnasts, and javelin throwers. Presentation consists of acute medial elbow pain with associated loss of command, control, and throwing velocity in pitchers. Attention should be given to associated risk factors including workload. Ulnar neuritis is a commonly associated condition because of its close proximity to the posterior band of the ulnar collateral ligament. Physical examination focuses on the ulnar collateral ligament, but also identifies associated pathology and kinetic chain factors that may predispose a player to injury. Tears are classified by location (proximal, midsubstance, distal) and extent (partial versus full thickness). Nonsurgical treatment may be a viable option for partial-thickness tears and includes rest from activity, flexor-pronator strengthening, and possible platelet-rich plasma injections.