BACKGROUND: Ulnar collateral ligament injury of the elbow is a sprain (tear) of one of the ligaments on the inner side of the elbow. The ulnar collateral ligament (UCL) is a structure that helps keep the normal relationship of the humerus (arm bone) and the ulna (one of the forearm bones). This ligament is injured in throwing types of sports or after elbow dislocation or surgery. It may occur as a sudden tear or may gradually stretch out over time with repetitive injury. This ligament is rarely stressed in daily activities. It prevents the elbow from gapping apart on the inner side. When torn, this ligament usually does not heal or may heal in a lengthened position (loose). Sprains are classified into three grades. In a first-degree sprain, the ligament is not lengthened but is painful. With a second-degree sprain, the ligament is stretched but still functions. With a third-degreesprain, the ligament is torn and does not function. (Source: Washington Orthopaedics & Sports Medicine)
SIGNS: Symptoms include pain and tenderness on the inner side of the elbow, especially when trying to throw; a pop, tearing or pulling sensation noted at the time of injury; swelling and bruising (after 24 hours) at the site of injury at the inner elbow and upper forearm if there is an acute tear; inability to throw at full speed; loss of ball control; elbow stiffness; inability to straighten the elbow; numbness or tingling in the ring and little fingers and hand; clumsiness and weakness of hand grip. (Source: Washington Orthopaedics & Sports Medicine)
TREATMENT: For those who have an acute rupture of the ligament or those who have failed therapy and wish to continue throwing competitively, surgical reconstruction (rebuilding the ligament using other tissue) is usually recommended. This procedure is known as the “Tommy John” procedure, named for the player whose career was saved when the ligament was reconstructed by Dr. Frank Jobe. The ligament reconstruction can be performed using a variety of soft tissue grafts obtained from the patient, but is most commonly carried out using the palmaris longus tendon from the forearm. Because this tendon provides biomechanical characteristics that are similar to those of the native ligament, and because there are no consequences from its absence, it makes an ideal ligament substitute. Some patients do not have a palmaris longus tendon and therefore require an alternative graft for reconstruction, such as one of the toe extensors. (Source: Washington Orthopaedics & Sports Medicine
NEW TECHNOLOGY: PRP therapy offers a promising solution to accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk.Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. When in their resting state, platelets look like sea sponges and when activated form branches. Platelets were initially known to be responsible for blood clotting.For the treatment, doctors take a small vial of a patient's blood, about 30 milliliters, and spin it in a centrifuge to separate the platelet-rich plasma from the other components. Then they inject the concentrated platelets at the site of the patient's injury. (Source: Orthohealing.com)
Preston Wolin, M.D.,Director Spetsmedicine at Weiss Memorial Hospital talks about PRP, a new way to help injured athletes.
What is PRP? How is it changing the way you might help athletes with different injuries?
Dr. Wolin: PRP stands for platelet rich plasma. The idea behind PRP is to use the body’s own natural healing mechanism to get muscle, tendon, and ligament injuries to heal without having to do surgery. Basically what’s done is the patient’s blood is taken from them, just like if you went to any laboratory or doctor’s office, and placed in a tube. The tube is spun down and it will pull out the parts of the blood that are very rich in what are called growth factors, and we know that the tiny cells that have those growth factors are called platelets. The process extracts the platelets, removes the part of the blood that is not going to help in the healing process, and gives us the factors which we can put back into the injured area to promote the healing.
It seems like it is a concentrated amount of those platelets that kind of supercharge the healing?
Dr. Wolin: Exactly right.
You said it was in muscles, tendons, and ligaments, correct?
Dr. Wolin: Yes.
Why is this a better idea for some versus Tommy John?
Dr. Wolin: We know that Tommy John surgery, which is an operation where the ligament on the inside of the elbow is reconstructed, is a very successful operation but it is an operation that takes at least a year to come back from for a pitcher. If we can change that timeframe from a year or more down to several months then that is a huge benefit to a pitcher, especially a young one like Eddie.
Koby Bryant went to Germany. Brian Urlacher apparently went to Germany. Is this the same thing? What’s the difference?
Dr. Wolin: There are different proprietary means of administering platelet rich plasma, there are different preparations, and there are a different number of injections that are given. So while the actual consistencies are closely held proprietary secrets, in a general way this is the same technology.
Why go to Germany? Are they giving them more? Is that the secret?
Dr. Wolin: I think it has to do with an individual’s perception of what the success rate are at any given location where they will have the treatment. Professional athletes clearly have a large stake in their futures and if one practitioner is able to produce successful results, then that is going to tend to produce more athletes going to that same place. Having said that, it is also true that there are a number of places where a number of professional athletes have had very successful results following platelet rich plasma or related types of therapies.
Could you talk about helping Eddie through the process?
Dr. Wolin: When you are dealing with a young athlete, it is very important that you take the time to tell them, their parents, their coach about what the injury is and what their prospects for recovery are. Now in Eddie’s case, he came to me after having seen another doctor who had recommended that he have the Tommy John operation. While I said he could have that operation, there was another alternative to the operation that could get him to the same place, which was basically taking him from his injured state back to his pre-injury state of being able to be a baseball pitcher.
Is it for everyone? or is this for certain athletes with certain kinds of injuries?
Dr. Wolin: Let’s take Eddie, for example. Eddie had a type of tear of his ligament that was a partial tear, not a complete tear, and so we know that PRP is best for partial tears of the ligaments and we know what location of tear heals better than others. You have to be realistic with the patient where if you do not believe that the PRP is going to work and that the surgery would be better you have to be honest and be able to tell them yes, some people are doing it for a complete tear, but our best evidence is that partial tears are the ones that heal best.
Can it be repeated?
Dr. Wolin: Some people do repeat the PRP therapy. Where we are right now I would say that, for example, with Eddie De La Riva if one PRP injection did not work probably another one is not going to work.
And in that case would Tommy John be his next best option then?
Dr. Wolin: Probably Tommy John would be the next best option, yes.