Ulnar Collateral Ligament of the Elbow Reconstruction

What is it?

Ulnar collateral ligament reconstruction, also known as Tommy John Surgery, is a procedure in which the ulnar collateral ligament (the ligament on the inside of the elbow) is replaced with a tendon from somewhere else in the body. The ulnar collateral ligament in a thick band of tissue that holds the ulna (lower arm bone) to the humerus (upper arm bone). This ligament can become damaged from a single traumatic event or from repetitive trauma, such as throwing a baseball. When this ligament is torn or damaged, the elbow becomes unstable. Many throwing athletes who develop this condition have pain in the elbow during and after throwing activities. They may also develop numbness and tingling in the hand due to stretching of the ulnar nerve at the elbow.

In order to properly diagnose a torn ulnar collateral ligament, your doctor will perform a physical examination and then most likely order either an x-ray or MRI to confirm.

What are the treatment options?

Most of the time, treatment for repetitive elbow injuries begins with a period of rest. Additional treatment may include physical or occupational therapy to restore flexibility and strength, changing throwing mechanics, or taking anti-inflammatories to reduce pain and swelling.

If pain does not improve with conservative management, and the athlete desires to continue throwing, surgical intervention may be considered. Athletes with an unstable or torn UCL are candidates for ulnar collateral ligament reconstruction. Most of the time, this ligament cannot be stitched back together, instead, it must be reconstructed. The torn ligament is replaced with a soft tissue graft, which acts as framework for the new ligament to grow on to.

Procedure Goals

Surgical treatment is designed to restore medial stability of the elbow. Full return to previous activities is the main goal. This is especially true for those athletes who want to remain active and competitive in sports. Successful treatment of the condition should improve or eliminate pain as well as any nerve related symptoms that may have been present.

Risks of the Procedure

Patients undergoing any surgery are subject to risks of infection, wound healing problems, nerve injury, deep vein thrombosis and pulmonary embolism. Infection rates are reduced in surgeries that employ smaller incisions.

Because this surgery is performed very close to nerves and blood vessels, it is possible that these will be injured as a result of scarring or entrapment. The ulnar nerve is especially at risk, with possible results being pain, numbness and weakness in the arm and hand.

Approximately half of patients who undergo UCL reconstruction lose five to ten degrees of elbow extension (the elbow’s ability to straighten fully). Most of the time, this does not affect strength or function.

Long-term complications can include chronic pain with throwing and chronic instability of the elbow.

What to Expect

Before Procedure

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear comfortable clothing including a button down shirt if possible.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

After surgery your arm will be immobilized in a splint for seven to ten days. During this time you should perform gentle range of motion exercises with the wrist and finger to keep blood moving and assist with healing. After the immobilization period, you will be put into a range of motion brace to gradually restore full range of motion. Rehabilitation with a physical or occupational therapist will begin about 6 weeks after surgery. Rehabilitation usually takes about a year and in some cases up to 2 years

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Dressing Care & Bathing

• Keep your dressing, splint and/or sling in place until your first post-operative visit.
• Do not bathe, shower or go swimming until bandages are removed.
• Keep your incision clean and dry until sutures are removed (usually two weeks after surgery).

Elevation

• Elevating is very important to help keep swelling and discomfort controlled and should be done as much as possible for the first three to five days, then as needed to keep swelling minimized.
• Elevate the affected extremity on pillows with fingertips pointing toward the ceiling.
• It is not necessary to elevate at night, so you may sleep in a comfortable position.
• Wiggle your fingers and thumb frequently to help reduce swelling and to encourage range of motion.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling.
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
• It is not necessary to use ice while sleeping.
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
• No driving while taking any narcotic pain medication!
• The pain medication may cause some nausea so take it with food.
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling in the foot, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at 785-843-9125.

Rehabilitation Plan - Exercises

Rehabilitation takes about a year and will be closely monitored by your doctor and therapist. You will have physical or occupational therapy where you will receive individualized exercises to help you regain full range of motion and increase strength.