Nonoperative Treatment of Ulnar Collateral Ligament Injuries

Abstract

The anterior bundle of the medial ulnar collateral ligament (MUCL) is the prime valgus stabilizer of the elbow. Athletes who throw overhead, such as baseball players, and javelin throwers, most commonly fall victim to this type of injury as the MUCL is subject to significant loads during the late cocking phase/early acceleration phase of the throwing motion [9,10,11]. The MUCL reconstruction procedure, or one of its variants pioneered by Jobe, has routinely been used to stabilize the medial elbow after MUCL injury. Surgery, however, may not be necessary in all MUCL injuries. This is especially true in younger patients who may present with a more acute form of the injury to the ligament in isolated anatomical areas, and have injuries more along the lines of a sprain, which is an interstitial tear without structural incongruity, or a partial tear. Rettig et al [23] provided the first large series of patients treated with nonoperative management for MUCL injuries, thus demonstrating that MUCL injuries respond to conservative management. A structured return-to-throwing protocol, external stabilization with bracing, physical therapy, and biologic adjuncts such as platelet-rich plasma are potential solutions that may permit athletes to return their preinjury level of play while simultaneously averting the morbidity and longer return-to-play associated with operative treatment.