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Elbow Lateral Collateral Ligament Tear / Strain Physiotherapy
lateral collateral ligament (LCL) strain or tears are those that damage the
soft tissue in our elbow's lateral collateral ligament complex (LCLC).
The LCLC consists
of four ligaments, of which, only two are typically referred to as the lateral
The four LCLC ligaments are:
collateral ligament (RCL) – joins the lateral epicondyle of the
humerus to the annular ligament below.
ulnar collateral ligament (LUCL) – connects the lateral epicondyle
with the supinator crest of the ulna.
ligament (AL) – also called orbicular ligament, encircles
the tip of the radius, maintaining contact with the ulna and humerus.
lateral collateral ligament (ALCL) – joins the supinator crest with
the lower margin of the annular ligament.
the RCL and LUCL are called the lateral collateral ligaments of the elbow. An
LCL strain may affect either one or both of these fibrous bands simultaneously.
injuries generally occur due to repetitive stress that damages the inner
tissues of the elbow joint. It is commonly seen in athletes and people who
frequently play overhead sports, like basketball, baseball, volleyball, etc.
condition is typically characterized by:
- Swelling, and
- Locking or catching of the elbow.
names for LCL strains include:
- Tommy John Injury
- Little League Elbow Syndrome
- Thrower’s Elbow
- Ulnar collateral ligament (UCL) injury
- Radial collateral ligament injury
- External lateral ligament injury
following article, we take an in-depth look at what LCL is and how it can
become strained. We also discuss the symptoms of LCL tear and the treatment
options available to people suffering from this type of elbow injury.
Let’s start with the
What Is the Lateral Collateral Ligament?
Not to be confused with the knee lateral collateral ligament injury, the lateral
collateral ligament of the elbow is a fan-shaped band of fibrous tissues
located on the joint’s medial side. It originates at the medial epicondyle of
the humerus and extends all the way to the proximal side of the ulna.
In other words, the LCL connects the inner side of your upper
arm with the inside of your forearm.
Its main function is to ensure joint
stability, particularly during rotational movement of the arm. The LCL ligament
also braces your elbow against extreme pressure from external sources. It
protects the joints from valgus stress and maintains a lateral-sided balance between
the three main bones in your arm.
Daily activities rarely strain the LCL band.
prolonged use of the joint for certain motions, such as pushing and throwing can
subject the ligament to laterally directed forces that can eventually cause it
The LCL is also prone to damage due to direct trauma and
forceful movement of the elbow into the varus position.
Elbow LCL injuries are often classified into three types:
- Grade 1 – Minor pain and
tenderness in the inner side of the forearm. Ligamentous integrity is
maintained as less than 10% of the fibers are damaged. There may be minuscule
or no tear in the soft tissues.
- Grade 2 – There is a
noticeable tear in the ligament and elbow joint laxity increases. Grade 2 LCL
sprains are accompanied by major pain, swelling, and soreness along the medial
side of the arm.
- Grade 3 – Means the LCL
is completely torn. Individuals experience joint immobility along with intense
pain, bruising, and swelling near the elbow. A grade 3 LCL injury is likely to
affect the surrounding cartilage, bony surfaces, and other structures in the
elbow capsule as well.
Generally, people with grade 1 and 2 LCL strains are able to
return to normal activities within 6 to 8 weeks. Treatment usually involves
conventional techniques like bracing or taping, followed by physiotherapy.
However, individuals with grade 3 LCL rupture require a relatively long time
period for complete rehabilitation. Nonetheless, with proper aftercare and
compliance with physical therapy, it’s possible to play high-end sport within
12 – 16 months.
What Causes Elbow LCL Strain?
LCL injuries are most often caused by the overuse of the
Games and practices that involve repeated throwing motions or
frequent stretching and contracting of the arm can overwork the ligaments,
thereby causing them to tear.
Another leading cause of LCL injuries observed in the
emergency department is falling on an outstretched hand.
LCL tears can also occur if you have
fractured your elbow or have previously suffered a joint dislocation.
If left untreated, a minor LCL strain can gradually lead to
This primarily includes the formation of bone spurs and
scar tissue, which can further progress into neuropathy or nerve dysfunction.
Symptoms of Elbow LCL Strain or Tear
People with a strained or torn elbow LCL band typically
report a combination of the following symptoms:
- Pain in the elbow
or along the medial side of the arm – Pain can be mild or severe,
depending on the percentage of fibers that have been damaged.
- Reduced range of
motion – You may have difficulty performing certain movements with the affected
arm. Extending or bending your elbow may become extremely hard and painful.
- Tenderness – The elbow and
inner side of the forearm may be sensitive to touch.
- Swelling – The affected
area may swell immediately after the injury or the swelling may develop after
continued use of a strained ligament.
- Numbness – You may feel a
tingling sensation in the arm if the strained ligaments compress an underlying
nerve in the joint capsule.
- Bruising – You may notice
skin discoloration on the inner side of the elbow. This happens when the narrow
blood vessels also get torn along with the ligament.
- Locking or
catching – It might feel like your elbow gets stuck or will ‘give
out’ if you try to move it at a certain angle.
- Loss of strength
in the arm and elbow – Individuals with severely torn LCL band may have trouble
lifting even considerably lightweight objects, such as a racquet or a glass of
Who Is At Risk of Developing LCL Strain or Tear?
- Throwing athletes like javelin players, baseball pitchers,
and lacrosse players are always at high risk of tearing their LCL tissues.
- People who frequently participate in racquet sports like
tennis, badminton, golf, and squash are also likely to rupture their ulnar or
radial collateral ligament at some point.
- Construction workers are susceptible to LCL injuries,
especially if they use ill-fitted equipment or follow poor tool handling
- Overtraining at the gym or not performing proper warm-up
exercises before a high-intensity workout can increase your chances of
straining the LCL band.
- People who play football, soccer, and rugby are usually at
high risk of straining their lateral collateral ligament as well. This is because
of the likelihood of fall involved in the game.
or adolescent athletes in contact sports can easily suffer LCL injuries due to
improper arm positions.
Conditions Similar to Elbow LCL Strain
Sometimes, the symptoms of elbow LCL injury can mimic the
symptoms of other elbow and hand conditions. These include:
- Flexor tendinitis
- Ulnar neuritis
- Olecranon stress fracture
- Valgus extension overload / Pitcher’s elbow
- Posteromedial olecranon fossa impingement
Treatment for Elbow LCL Strain
If you have pain along the medial side of your elbow that
doesn’t go away, it’s essential to see a doctor without delay. A physician will
carefully examine the joint and may also do a medical scan (x-ray, MRI, etc.,)
to confirm if it’s a lateral collateral ligament injury.
Depending on the severity of the tear, they will determine a
treatment plan. This can include a combination of the following:
- Non-steroidal anti-inflammatory medicines (NSAIDs) for pain
- Using a brace or customized thermoplastic splint to stabilize the elbow and prevent
further strain on the ligaments
- Elbow hand therapy or elbow physiotherapy to manage pain as well as restore joint strength and function
- Following the rest, ice, compression, elevate (RICE) regimen
for speeding up recovery
People with a torn or strained elbow LCL band generally do
not require surgery.
However, in some cases, it may become necessary to follow
an operative procedure if the tissues rupture in conjunction with a joint
fracture or bone displacement. Elbow hand therapy or elbow physiotherapy will be crucial for postoperative
pain management and proper joint recovery.
How Physiotherapy Can Help People with Elbow lateral collateral ligament Injury
Physical therapy is an important protocol for healing a
strained or torn lateral collateral ligament in the elbow joint.
Our expert therapists work closely with patients to prescribe
the right exercises for their particular condition. The main aim is to ensure
efficient recovery and help the individual regain healthy joint and muscle
For this, we use a range of gentle mobility and flexibility
moves. When done properly under the supervision of trained physiotherapists, this
can gradually help you complete the full arc of motion without any discomfort. Treatment
at a physical therapy center can also include alternative methods, such as:
Our master-level therapists and physical trainers can also
educate you about proper throwing mechanics and help improve your arm
coordination and balance techniques during sports so you can avoid re-injury
when you return to your favorite games.
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