Coverage of sports injuries often creates or reinforces myths. David Ring and Casey M. O’Connor, M.D., an orthopedic surgery resident at Albany Medical Center, help readers make sense of star athletes’ musculoskeletal disease and injury so readers can be better prepared to manage their own conditions.
José De León, 25 years old, was diagnosed with a torn medial collateral ligament (MCL) in his right elbow this spring. Throwing athletes (baseball pitchers and javelin throwers) can develop a looseness in the MCL after years of repeatedly throwing as hard as possible. In baseball, a single fastball creates enough force to completely tear the MCL, but the stabilizing force of the muscles prevents this. The theory is that repeated small sprains (ligament tears) outpace the body’s healing capacity leading to thinning of the MCL. A thin MCL leads to joint looseness and a specific pattern of elbow arthritis, called valgus extension overload.
All successful throwing athletes have changes in their elbow over the years. They all develop some thinning of the MCL and some level of arthritis. So “injury” is not the correct term. On occasion, the thinned ligament has an acute complete tear, but more typically it is a gradual thinning and arthritis in the elbow make a pitcher less effective.
Strengthening of the forearm muscles that stabilize the elbow can help manage symptoms and help throwers be effective again. If there is substantial laxity, the MCL can be reconstructed by taking a tendon from another part of the body and creating a new ligament. But this means a year off from throwing and does not always get throwers back to the same performance level.