UCL or Ulnar Collateral Ligament injury (MCL Ligament Injury) of Elbow leads to instability and pain on the ulnar (little finger) side of the elbow. Clinical examination to assess site of pain, tenderness, stress test of the Elbow gives enough pointers to diagnose, however the extent of the tear wouldn’t be easy to decipher with examination alone. 

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Diagnosis

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X-ray. X-ray is performed and is useful to rule out any bone avulsion injuries, however, ligaments are not visible on the X-ray.

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MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the UCL ligament injury. In addition, it helps to assess the condition of the rest of the Elbow Joint, as associated injuries such as coronoid process of ulna fracture, LUCL injury and radial head fracture. 

 

 

Treatment

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Non-surgical Treatment

 

The Elbow UCL ligament injuries can be treated with a ROM Elbow Brace for 6 weeks. In majority of patients this would be sufficient. If healing well this would be followed by stretching exercises to get the mobility back. In patients with poor healing or no improvement, it becomes necessary to get an MRI Scan done to assess the extent of the injury.

 

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Partial UCL Ligament tears

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In partial tears which have refused to heal with simple splinting, a PRP (Platelet Rich Plasma) Injection and  the ROM Brace for 4 weeks is recommended. Here PRP stimulates the healing process and the brace immobilizes so that the ligament can stand a better chance to heal.

 

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Complete UCL Ligament tears

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Complete UCL ligament tears need either the ligament repair or reconstruction. Depending upon the condition of the remaining ligament tissue, either repair of reconstruction can be done. UCL repair with fiberwire and fixation to the humerus end using suture anchor is an option if the remaining ligament tissue is in good condition. Alternatively, UCL ligament reconstruction using gracilis tendon harvested from thigh/ palmaris longus tendon harvested from the forearm of the same side is an effective way of reconstructing the UCL. The tendon is fixed to the bone by using bio-suture anchors. Alternatively, fiber-tape can be used to reconstruct the ligament. 

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Rehabilitation

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Post-surgery, you can expect to be in a thick dressing for 4 days. In patients with ligament reconstruction physiotherapy starts early. Range of movement exercises will start after 4 days. After 4 weeks strengthening exercises for the muscles controlling the elbow are started. Full functionality of the elbow can be achieved by 3 months.