UCL Injuries in Overhead Throwers

 

Ulnar Collateral Ligament Injuries in Overhead Throwing Athletes

Wyatt Kurzejeski, SPT

 

Background:

As someone who played collegiate baseball, and cherishes my playing days dearly, this population has always held a special place in my heart. While I personally struggled with shoulder injuries throughout my playing career, I had many friends lose valuable playing time at the mercy of elbow injuries. As physical therapists, whether we go on to work directly with an athletic organization, or rather in a general outpatient orthopedic setting, we are likely to run into patients with elbow pain stemming from an injury to the UCL. Physical therapy was absolutely essential in allowing me to continue playing the sport that I loved. I am hopeful the results of this capstone project can assist not only myself, but others in our program as well, in providing a similarly valuable service to injured athletes in our future practice.

Statement of Need:

Overhead throwing athletes, particularly baseball players, are highly susceptible to injury due to the nature of the high-demand dynamic movements associated with overhand throwing. UCL injuries in the elbow can be a devastating injury for these athletes, resulting in an entire season of lost competition. Additionally, the prevalence of UCL tears has been steadily increasing over the past decade, across all levels of competition – youth, high school, collegiate, and professional. Whether conservative treatment or surgical intervention is opted for, proper physical therapy is crucial for a successful return-to-sport outcome. It is imperative that we, as physical therapists, feel competent at evaluating and treating these athletes.

Purpose:

The purpose of this project is to address a knowledge gap that I believe exists within our DPT curriculum. In my opinion, our program is lacking in specifics when it comes to diagnosing and treating injuries in athletes. While we have a good amount of course content focused on shoulder injuries – diagnostics, evaluation, and treatment, minimal clinical information is presented regarding UCL elbow injuries. For anyone who wants to work with athletes in future practice, I believe it is important to understand the current best practice approaches for UCL injuries. The products generated from this project are specifically tailored towards DPT students, and practicing physical therapists, to enhance their confidence and competence when treating athletes with UCL injuries.

Products:

Final products are linked below, and were created to serve as an adjunct to the PHYT734 Musculoskeletal II course, in the fall of the 2nd year of the UNC DPT program.

Products include: a VoiceThread presentation (approximately 1-hour in length), a comprehensive literature review, and an evaluation survey to be completed by those who view the presentation.

• UCL Injuries VoiceThread
• Capstone Lit Review
• Capstone Evaluation

Evaluation:

Adjustments and additions to the materials were made along the way, as per feedback from my project advisor and committee members.

As linked above, I created an evaluation survey designed to assess the quality and effectiveness of my presentation. This form will be completed by 2nd-year DPT students who view the VoiceThread presentation during the upcoming Fall semester. I will utilize feedback from this form to enhance any future educational products.

Self-Reflection:

I found the entire process of this capstone project to be highly educational. There is no doubt that I not only expanded my clinical knowledge, but also enhanced my research evaluation skills – something I had previously felt lacking in. I feel much more confident in my ability to efficiently and effectively review current evidence surrounding a clinical question, and to apply it in practice. I cannot stress enough the importance of choosing a topic that is of personal interest, as this made the process of scouring research much more enjoyable than it otherwise could have been. I also think the way this project tied into the EBPII course in the Fall semester was an excellent way to help us build our project steadily over time. I appreciate the degree of freedom that we are granted in choosing this project, as I feel it allowed me to choose something that will directly contribute to my personal and professional development. I am hopeful the final VoiceThread presentation I have created will not only serve as useful material for future UNC DPT students, but will also be an effective tool that I will refer back to as I go forward in clinical practice. Looking back on the process, I am thankful it went very smoothly, with no major hitches, or issues with timing. There was definitely a learning curve associated with using VoiceThread tools for the first time, but the timelines we generated helped me prepare and stay on track. One of the downsides of this process, in generating materials suitable for the professional education of DPT students, a lot of the content may be too technical for other subgroups who play a critical role in the prevention of UCL injuries. However, the evidence is well-established and important, and could likely be re-worked in a manner that could inform coaches, parents, and players directly.

Acknowledgements:

First off, I would like to extend thanks to all UNC faculty who have contributed to my education over the past three years. I cannot thank our faculty enough for their time and effort.

Special thanks to my capstone advisor, Jon Hacke PT, DPT, MA. Jon was integral at helping me narrow down the focus of my project, and provided helpful instruction during the process. Additionally, Jon is the instructor for the PHYT734 course that these materials were designed to supplement.

I would also like to thank my committee members, Joe Orbaczewski PT, DPT, CSCS and Stephanie Milosovic PT, DPT. Both Joe and Stephanie provided useful feedback and instruction that contributed to my final products.

Thank you to all three of these individuals for being willing to serve on my committee, and for taking time out of their busy schedules to offer assistance and guidance. Please know that your contributions are deeply appreciated.

References:

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2. Patel RM, Lynch TS, Amin NH, Calabrese G, Gryzlo SM, Schickendantz MS. The thrower’s elbow. Orthop Clin North Am 2014;45(3):355-376. doi:10.1016/j.ocl.2014.03.007.
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