Two Unusual Presentations of Ulna Collateral Ligament Injury in Elite Level Pitchers
Current Sports Medicine Reports, 2021
Introduction Elbow injuries are common in baseball and have been well documented. In 1986, Jobe e... more Introduction Elbow injuries are common in baseball and have been well documented. In 1986, Jobe et al. (1) first described his ulnar collateral ligament (UCL) reconstruction as the “Tommy John procedure”. Since that time, surgical outcomes have been improved bymodifications in fixation methods, graft tensioning, and surgical approach. Erickson et al. (2) evaluated 179Major League Baseball (MLB) pitchers who underwent UCL reconstruction from 2010 to 2013. Of this group, 83% returned to pitching in MLB while 97.2% returned to at least the minor leagues. Saper et al. (3) studied 140 adolescent baseball players undergoing UCL reconstruction, 97.8% of whom returned to sport while 89.9% returned to the same level of competition or higher. Conservative and preventative management for UCL injuries include focused rehabilitation targeting pitching mechanics, shoulder kinematics, core and extremity strength, and specialized throwing programs (4). Platelet-rich plasma injections also have shown promise in partial injuries (5). Other elbow injuries include olecranon stress fractures (OSFs), valgus extension overload, and loose bodies (4,6–11). However, combinations of these pathologies with UCL injuries have not been highlighted. The cases presented here were collected over a 3-year period and uniquely involve a simultaneous combination of elbow and UCL injury, where the presenting complaints were not consistent with an injury to the UCL. With appropriate physical examination and advanced imaging, the concomitant injuries were identified and treatment was initiated.
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