On Friday, March 10th it was announced that Indians’ right handed pitcher Cody Anderson incurred a sprain of the ulnar collateral ligament (UCL) in his right (pitching) elbow. The team has shut the 26-year-old down from baseball activities for an indefinite period of time. Anderson is currently seeking a second opinion before the 2016 American League Champions decide the next course of action for Anderson and his troublesome right elbow. Worth noting, Anderson was working his way back from surgery he had in November of last year to address posterior elbow impingement when his most recent elbow injury occurred.
What is it? The ulnar collateral ligament (UCL) is located on the medial side of the elbow and serves to help stabilize the elbow while pitching, throwing etc. When standing upright, with the palms facing forward, medial refers to the side of the elbow closest to the body. The UCL connects the humerus (upper arm bone) to the ulna (one of the two long bones in the forearm). In overhead athletes, such as baseball players, the UCL is subject to high amounts of repeated force and therefore can be very vulnerable to injury. The term “sprain” refers to the over stretching or tearing of a ligament, in this case the UCL. Sprains are graded on a scale from one to three, with a grade one sprain being the least severe and representing a slight overstretch of a ligament and a grade three sprain being the most severe and represents a complete tear of the ligament. Grade one sprains are classified as mild, grade two sprains moderate and grade three sprains severe.
How is it fixed? The severity of an injury to the ulnar collateral ligament will usually dictate the treatment method utilized, with more conservative management utilized for less severe sprains and surgical management for more severe sprains. Conservative management consists of a period of rest/being shut down from baseball activities; time off allows the medial elbow to rest from the stresses incurred while throwing repeatedly. In some instances, platelet rich plasma (PRP) injections may be utilized to help accelerate the healing process. PRP injections utilize the patient’s own blood via a blood draw, which is then spun in a centrifuge to increase platelet concentration, and then is re-injected into the patient at the location of the injury. When grade three ulnar collateral ligament injuries occur, most often, surgical intervention is indicated. The surgery performed to repair a torn UCL is termed an ulnar collateral ligament reconstruction or Tommy John surgery. The surgery works to re-anchor the UCL and restore normal anatomy of the elbow in an effort to allow the patient to return to their prior level of function. Following surgery, a long road of rehabilitation begins, that can last upwards of one year in length. Following surgery, a period of bracing will be used to allow time for healing of the reconstructed UCL to occur; the length of bracing will vary based on the surgeon’s protocol but can be anywhere from 6-8 weeks. During rehab, efforts to restore, full, pain free range of motion and strength of the elbow and affected arm are made with an eventual goal of reintroduction of dynamic activities. Specific progression through a UCL reconstruction postoperative protocol is based on a patient’s ability to meet all goals of one phase of the protocol before being allowed to advance to the next. The ultimate return to throwing/baseball decision is made by the patient’s surgeon.
My take. The initial MRI Anderson received indicated the sprain of his right UCL was mild in nature or a grade one sprain. If this is truly the case, I would like to believe conservative management would be the route the Indians take in this situation. However, if something else crops up, upon receiving a second opinion, the treatment methodology may change. It is tough to get a gauge on how long Anderson will be out at this time so we will have to wait and see the results from the second opinion on the California native before truly knowing how much time he will miss.
We will continue to monitor the status of Cody Anderson and will provide the most up to date injury breakdown and analysis as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.