i need a power point

Ulnar Collateral Ligament Injuries

Student’s Name

Institution

Date

Ulnar Collateral Ligament Injuries

The human body is comprised of networks and subnetworks of ligaments all through its system. It is startling how an injury to any of these ligaments affects the normal operation and mobility of a human being. Luckily, with an intensive care plan directed towards these structures, proper health and normal functioning can be guaranteed regardless of any strenuous activities directed towards them. This study research focuses on the injuries of the Ulnar Collateral Ligament (UCL). It discusses the relevant anatomy around the elbow with a further analysis of the main causes of such injuries, the symptoms relating to the injuries, and the potential treatment methods available to ensure full recovery of the ligaments.

The Ulnar Collateral Ligament structures are found at various regions of the hand including the thumb, wrist, and elbow areas. In the thumb, the UCL runs beside the metacarpophalangeal joint while at the wrist, it is displayed as a rounded cord at the wrist joint where it is attached to the end of the ulna's styloid process. At the elbow, the ligament is displayed as a thick, triangular band with two sections: the anterior and posterior regions. The anterior is attached to the front and upper section of the medial epicondyle of the humerus, while the posterior section is attached to the lower and back section of the forearm; radius and ulna (Healthline Media, 2015). The UCL acts as the primary stabilizer of the elbow through its various movements like throwing and lifting items. With unexpected mishaps however, these ligaments can be exposed to a number of injuries that ranges from slight damages and inflammation to gradual widespread tear of the ligament.

Although the UCL is rarely strained by daily activities, its injury may rely on sport activities such as baseball, javelin, volleyball and racquet sports that involve throwing, or a post-elbow surgery. It can also be ruptured by sudden traumatic accidents such as elbow dislocations or injuries that arise from gymnastics, wrestling and height falls, but the most common injury mechanism occurs over a long period of time with steady stretching of the ligament or degradation of these tissues from repetitive elbow motions across the elbow joint. For this reason, UCL injury is common among baseball pitchers, javelin throwers and athletes playing volleyball, racquet sports.

Apart from the type of sport one engages in, the age of the athlete also comes to play as a cause for UCL fracture. From a sports medicine research conducted, it was reported that younger athletes were more likely to sustain less severe UCL injuries than the older athletes in the examined patients presented for medical care (Zaremski, McClelland, Heather, & Horodyski, 2017). This may be due to a change in bone brittleness as one ages and the prolonged tear and wear from repetitive motions exerted at elbow joints that cause severe UCL injuries among the old people. There is also a rapid recovery pattern displayed from these injuries at the youthful stage due to progressive tissue growth compared to the aged whose cells and tissue growth are limited. As a result, varied signs and symptoms are displayed that may differ depending on one’s age.

Among the early symptoms exhibited is an actual tear that is felt as a ‘pop’. This results to an internal elbow pain that deters one from progressing the sport activity immediately after it has occurred. In most cases, an athlete also experiences numbness and tingling of the elbow, forearm, or hand as a result of ulnar nerve irritation. A long term effect felt among the aged ranges from a limited ability to throw or a decrease in the throwing velocity to a sense of looseness or instability in the elbow. With the young, these effects can be treated early on their onset and the elbow’s functionality restored back to normal. However, the medical intervention applied to these injuries depends on the severity of the injury experienced.

The UCL injury treatment strategy starts off with a physical examination that may involve arm bending or pressure application across the elbow joints to establish painful areas. This examination is further supplemented with fluoroscopy - a continuous low-level X-ray - that demonstrates excessive motion in the elbow joint as a result of the injury (Johnson & Alan, 2014). This is typically compared to the motion of the other elbow and the differences measured to detect exact tear locations of the ulnar ligament. Depending on the accuracy of the image displayed, another diagnosis technique such as MRI scanning can applied.

A magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) is then used to make visible ligament fractures and elbow’s soft tissues that were invisible through Fluoroscopy. Other than offering a platform to distinguish various tissue and ligament disorders that exhibit similar symptoms, the MRI scans also provides an increased resolution accuracy in establishing the severity and location of an injury by obtaining images in axial, coronal oblique and sagittal oblique planes relative to the transepicondylar axis (O'Dell et al., 2015). All these diagnosis techniques are carried out at the initial stages to confirm the diagnosis, establish other possible damages to the ulnar collateral ligaments and create treatment plans for the injuries exhibited.

There are quite a number of treatment options available depending on the severity of the UCL injury. These methods range from non-surgical therapies such as the use of ice, rest plans and prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) for mild injuries to surgical therapies such as UCL reconstructions, Arthroscopy and Ulnar nerve anterior transposition among others for acute UCL injuries (Mohindra, Doe, & Kumar, 2016). The surgical options however, may be viable if for instance, a patient doesn’t respond to non-surgical methods, or an athlete insists on resuming the strenuous overhead or throwing activities. Though surgical procedures are difficult to erase from the human memory and at times plays a critical role in ensuring a smooth recovery curve, at the end of the day the patient has a say in his/her treatment plan.

From a surgical point of view, ligament tears have always proven difficult to stitch them back together. As a result, the UCL reconstruction technique famously known as Tommy John surgery, has been emulated in many elbow surgical procedures to support UCL’s restoration (Tyler Wheeler, 2017). In order to repair the torn UCL for restoration of the elbow’s mobility and stability, the ligament is reconstructed through a tissue graft obtained from a patient’s body region such as the hip and wrist or from a dead body region. A tunnel is then drilled in the ulna and humerus and the graft sewn through the tunnels in a figure-eight pattern to reconstruct the ligament. This graft acts as a scaffold for the new ligament to grow on. To increase the strength of the sewn graft, the remnants of the originally fractured ligaments are attached to the muscle. After the treatment procedure, a patient is absorbed into a recovery plan to ensure full restoration of the elbow functionality.

If non-surgical procedures were used to treat the UCL tear, recovery might last anywhere from several weeks to several months depending on the range of elbow motions a patient would like to achieve. However, if the UCL reconstruction technique was used, the recovery timeframe might take close to a year and at times longer to achieve a full functional ability of the elbow. All these are dependent on the effectiveness of the recovery plan administered to a patient with keen adherence to precautions and contraindications during the treatment and recovery process. There are various Physical Therapy (PT) interventions that are imperative to the recovery progress during the post-operative care.

These recovery interventions are divided into phases ranging from phase one to three. The early phases of post-operative care involves specific exercise time frames, restrictions and precautions to limit tissue damage while protecting the healing of the tissues and the surgical fixation. The later phases of rehabilitation on the other hand, are presented in a standard based progression, where improvement to subsequent levels are based on elbow strength and control (UW Sports Medicine, 2018). The first phase - acute phase is initiated 5 to 7 days after surgery with an aim of not only protecting the healing tissues and decreasing pain and inflammation but also preventing muscular atrophy and initiating the elbow range of motion. The patient wears a splint to restrain the elbow and a range-of-motion (ROM) brace to gain the full elbow joint motion. A critical precaution however, should be taken during ROM exercises to avoid valgus force or positioning that might damage the tissues.

The second phase - subacute phase follows 6 weeks after the surgery. This phase’s goals are directed towards protection of the reconstruction during continued healing, improving the muscular strength of the arm, shoulder and trunk, increasing the overall strength and endurance with maintenance of full elbow ROM. The patient is exposed to gentle active and active assistive ROM for the elbow and wrist and the patient advised to avoid activities that overstress the graft. At the later stages of the phase, the brace is discontinued.

At the third phase - chronic or full function phase, the patient’s ROM displays a full elbow mobility. This phase aims at maximizing the rotator cuff and scapular strength in throwing positions and postures. The patients are also educated on throwing mechanics while maximizing on their dynamic neuromuscular control with shoulder and elbow stabilization. After the one year recovery period, the patients may exhibit a pain-free throwing ability and the arm’s functionality restored to its normal strength and range of motion. However a precaution should be taken if an arm soreness still exist on the patient’s arm. There are a number of recommended physical therapy interventions that can be performed by a Physical Therapy Assistant although beyond his operating scope, but can help stabilize a patient’s recovery process.

Given the trusting and close relationship with patients, PTAs are able to monitor and provide quality care to patients thus provides an asset to patient care. However, a PTA’s role and responsibility is limited to the assigned tasks by the PT. There are critical roles that are only performed by a PT and doesn’t extend to the PTA’s scope of work though might help in rapid recovery progression of the patients. Wound management and elbow joint mobilization procedures that does not require invasive methods can easily be performed by PTAs. It all depends on the skills and competency of the PTA. To provide a quality care relating to these activities however, PTAs are advised to take up addition training to supplement their skills on these critical patient care.

The following table displays an example of a 3 week post-operative care after an UCL reconstruction surgery. The 3 week care is a subset of the first phase of the recovery process. The main goals of the phase ranges from decreasing elbow pain and inflammation, retarding muscular atrophy, protecting the healing tissue to reestablishing a non-painful range of motion.

There is no doubt that a successful UCL recovery sprue up from a correct treatment and recovery plan administered to patients. Though the value of these methods might not be 100% effective, it is a prudent choice to adopt healthy plans when engaging our elbows to strenuous activities.

References

Healthline Media. (2015, February 17). Ulnar collateral ligament. Retrieved from Healthline : https://www.healthline.com/human-body-maps/ulnar-collateral-ligament#1

Johnson, & A. B. (2014). Procedures in Orthopedics: Fluoroscopic Elbow Injections. JBJS Journal of Orthopaedics for Physician Assistants, 5-6.

Mohindra, M., Doe, J., & Kumar, J. J. (2016). Fundamentals of Orthopedics. London: The Health Science Publisher.

O'Dell, C., Urena, J., Fursevich, D., Sanchez, E., LiMarzi, G., & Bancroft, L. (2015). Imaging sports-related elbow injuries. Applied Radiology: The Journal of Practical Medical Imaging and Management.

Tyler Wheeler. (2017, October 24). Tommy John Surgery. Retrieved from WebMD : https://www.webmd.com/fitness-exercise/tommy-john-surgery-ucl-reconstruction#2

UW Sports Medicine. (2018). Rehabilitation Guidelines for Elbow Ulnar Collateral Ligament (UCL). Retrieved from UW Health: https://www.uwhealth.org/files/uwhealth/docs/.../SM_UCL_reconstruction.pdf

Zaremski, J. L., McClelland, J., Heather, V. K., & Horodyski, M. (2017). Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries. Orthopaedic journal of Sports Medicine, 5(10).