The Ulnar Collateral Ligament

The ulnar collateral ligament does not get much press but it is the reason for most chronic medial elbow pain. This ligament supports the inside of the elbow. It is responsible for holding the ulnar bone to the distal end of the humerus. This enables the arm to flex, pivoting at the elbow. An athlete's complaint of pain on the inside of the elbow will cause the orthopedist to examine the lateral epicondyle's "sister," the medial epicondyle. The orthopedist will quickly diagnose medial epicondylitis and recommend NSAIDs, or something even worse in our opinion, the cortisone injection.

The ulnar collateral ligament is approximately three-quarters of an inch distal to (away from) the medial epicondyle. It is a tremendously important structure stabilizing the medial (inside) part of the elbow. When the elbow is flexed 90 degrees, as occurs during a wrestling match or football tackle, the ulnar collateral ligament distributes over 50 percent of the medial support of the elbow.^1-3 It has also been shown to be the most important stabilizing structure for the elbow in response to an elbow blow to the lateral side (valgus stress).⁴ Another study showed that weakening of the ulnar collateral ligament had a profound effect on range of motion of the elbow.⁵ This could effect quite a number of different athletes in various sporting events.

The ulnar collateral ligament is also important because it refers pain down the arm into the little finger and ring finger. This same pain and numbness distribution is seen when the ulnar nerve is aggravated. The ulnar nerve lies behind the elbow and is the reason hitting your funny bone causes pain. Because most physicians are not familiar with the referral pattern of ligaments, elbow pain and/or numbness into the little finger and ring finger is often diagnosed as an ulnar nerve problem, called Cubital Tunnel Syndrome. A more common reason for this condition is ligament laxity in the sixth and seventh cervical vertebrae or in the ulnar collateral ligament, not a pinched nerve.

Who to call for elbow pain – Orthopedist or Prolotherapy physician?

A common mode of treatment for ulnar nerve problems is surgery. The orthopedist removes the ulnar nerve from its normal home in the bottom of the elbow and moves it to the side. An athlete given surgery as the mode of treatment for elbow pain should obtain a non-surgical second opinion from a Prolotherapy doctor who is competent in the treatment of Hackett-Hemwall Prolotherapy. Surgery should normally be performed only after all conservative options have been attempted.

1. Morrey, B.F. The Elbow and Its Disorders. Second Edition. Philadelphia, PA: W.B. Saunders Company, 1993.
2. Tullos, H. Elbow instability. In Baker, C. (ed.), The Hughston Clinic Sports Medicine Book. Philadelphia, PA. 1995. pp. 317-323.
3. Morrey, B. Articular and ligamentous contributions to the stability of the elbow joint. American Journal of Sports Medicine. 1983; 11:315-319.
4. Hotchkiss, R. Valgus stability of the elbow. Journal of Orthopedic Research. 1987; 5:372-377.
5. Morrey, B. A biomechanical study of normal functional elbow motion. Journal of Bone and Joint Surgery. 1981; 63A:872-877.