AOSSM/AANA Specialty Day 2020-Decision-Making and Treatment of Partial UCL Tears

Decision-Making and Treatment of Partial UCL Tears

Pdf Summary

This presentation by Dr. Steven B. Cohen reviews the diagnosis and treatment of partial ulnar collateral ligament (UCL) tears, particularly in overhead throwing athletes like baseball players. Clinical symptoms include medial elbow pain during late cocking or early acceleration phases of throwing, loss of velocity/control, and pain on valgus stress. MRI-based classifications reliably distinguish partial from complete tears and their locations (proximal, mid-substance, distal), which are predictive of treatment outcomes.<br /><br />Studies show that nonoperative management—including active rest, rehabilitation targeting elbow, shoulder, scapular, and core muscles, and gradual return to throwing—is effective for many partial UCL tears, especially proximal, low-grade tears, with return-to-play (RTP) rates around 80-90%. However, distal partial tears and high-grade or complete tears more commonly fail conservative treatment and require surgery. Stress ultrasound and biomechanical data highlight the significance of tear size and location on joint stability.<br /><br />Use of biologics, such as platelet-rich plasma (PRP), in partial UCL injuries has mixed results. PRP may prolong time to return to throwing but does not significantly increase RTP rates or reduce need for surgery. Treatment decisions should consider patient age, tear grading, tear location, sport level, and overall athlete well-being.<br /><br />When surgery is needed, options include repair with or without internal brace or reconstruction. Overall, conservative treatment is viable for many partial UCL tears, but careful MRI-based classification and clinical evaluation guide surgical indications. Rehabilitation protocols remain foundational, and ongoing debate continues regarding optimal surgical techniques.<br /><br />In sum, successful management of partial UCL tears depends on injury extent and location, functional demands, and patient response to nonoperative therapy, with surgery reserved for failures or more severe injuries.

Keywords

partial ulnar collateral ligament tears

UCL injury diagnosis

overhead throwing athletes

medial elbow pain

MRI classification of UCL tears

nonoperative management UCL

return to play rates

platelet-rich plasma PRP

UCL surgical repair

rehabilitation protocols elbow injury