Today’s article is titled “Return-to-play outcomes in high school baseball players after ulnar collateral ligament injuries: dynamic contributions of flexor digitorum superficialis function.” This article from Sakata et al. was performed from Toyota Memorial Hospital, Yokohama Minami Kyosai Hospital, and Yokohama Sports Medical Center.
Briefly, the ulnar collateral ligament (UCL) of the elbow attaches the medial (inside) aspect of the lower humerus to the upper portion of the ulna. Because muscles such as the flexor digitorum superficialis (FDS) also attach to the inner aspect of the elbow they can act as dynamic stabilizers.
More than 400,000 high school athletes play baseball in the U.S. and so the more studies that add to decision making in this population the better. The authors looked at both MRI and US of the elbow in this study. They graded UCL injuries as previously described by Ford et al: I, intact ligament with or without edema; IIA, partial tear classified as a tear with incomplete ligament fiber disruption; IIB, chronic healed injury with ligament thickening indicative of a previous injury but without fiber disruption; and III, complete tear with full ligament disruption. They also looked at US under resting conditions at 30 and 90 degrees of elbow flexion and under valgus conditions with or without FDS contraction.
One takeaway from the results is that they had a high return to the same level of sport, 83.6%, with nonoperative treatment with 8 failures returning to sport at a lower level and only one resulting in surgery. They did show a significant difference between presence of ring down artifact on ultrasound at rest and valgus testing but no difference between joint space in the group that returned to the same level and the group that did not. They showed a 100% return to the same level with grade I UCL injuries, 86.4% with grade IIA, 75% with grade IIB, and 0% with grade III.
Patients should note that rehab may seem like a slow process and some athletes in this cohort did not advance to an interval throwing program until 3 months after initiating the rehab process. However, patients should also be encouraged that return to sport remains high with nonoperative treatment of partial UCL tears.
UCL injuries in the news:
If you have elbow pain from UCL injury and want to discuss what is the best option for you call my office at 512-244-4272 or schedule an appointment online.