Skip to content

Patients › Elbow

Sugat sa Ulnar Collateral Ligament (Tommy John Injury)

PDF

The medial elbow ligament injury of throwers — how it presents, when rehab is enough, and what Tommy John reconstruction involves.

Isang baseball pitcher sa huling yugto ng paghahanda bago itapon, na may sakit na nakatuon sa loob ng siko.
Sugat sa ulnar collateral ligament (Tommy John): ang paulit-ulit na valgus stress habang nagtataya ay nagdudulot ng strain sa ligament sa loob na bahagi ng siko. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang nararamdaman mo

Kung marami kang pagtatapon (baseball, javelin, o anumang isport na may mahigpit na pagtatapon sa itaas ng ulo), maaaring mapansin mo ang pananakit o sakit sa loob na bahagi ng siko. Madalas itong dumating sa sandali ng pinakamataas na pagsisikap, bago ang iyong braso ay mabilis na umunlad papunta sa harap upang palayain. Maraming nagtatapon ang naglalarawan nito bilang malalim, patuloy na pananakit sa itaas ng buto na bumubuo sa loob na bahagi ng siko.

Ang ibang karaniwang senyales ay ang pagbabago ng iyong pagtatapon. Nawawalan ka ng kaunting bilis, nawawalan ng karaniwang katumpakan o "lakas" ang iyong mga pagtatapon, o simpleng hindi mo na kaya ang pagtatapon nang matigas o matagal na dati. Minsan, ang sakit ay unti-unting lumalala sa loob ng isang season; minsan, isang pagtatapon lamang ang nagdudulot ng matulis na sakit o "lakas" at biglang naramdaman ng siko na hindi matatag o walang kapakinabangan.

May ilang tao rin ang namamalas ng pamamanhid, kawalan ng pakiramdam o pamamanhid na dumadaloy patungo sa anghas at maliit na daliri. Nangyayari ito dahil may isang nerbiyos na dumadaan sa likod ng loob na siko, at pamamaga o kawalan ng katatagan sa lugar na iyon ay maaaring mag-irita nito.

Ano ang nangyayari

Ang matibay na banda ng tisyu na tinatawag na ulnar collateral ligament (UCL) ay matatagpuan sa loob na bahagi ng iyong siko. Ang tungkulin nito ay pigilan ang siko na magbukas sa loob na bahagi kapag may puwersa na tumutula sa direksyong iyon, isang galaw na tinatawag na valgus. Ang paghahagis ay nagdudulot ng napakalaking, paulit-ulit na stress sa ligamentong ito. Ang bawat matinding paghahagis ay bahagyang umaunat sa ligamento, at sa loob ng libu-libong paghahagis, maaaring dahan-dahang magkasira, manipis, at mahina ang ligamento. Sa mas bihirang kaso, ang isang napakalakas na paghahagis ay maaari nitong punitin.

Kapag sira ang UCL, hindi na nito kayang hawakan nang mahigpit ang siko, kaya ang kasukasuan ay bahagyang maluwag sa ilalim ng mga puwersa ng paghahagis. Ang kaluwagan na ito ang nagdudulot ng sakit, pagkawala ng bilis at kontrol, at minsan ay mga sintomas sa nerbiyos. Ito ang parehong pinsala na naging sikat bilang "Tommy John," na pinangalanan mula sa unang baseball pitcher na nagkaroon ng pagsasaulit ng ligamento sa pamamagitan ng operasyon at bumalik sa paghahagis.

Mahalagang malaman na ito ay halos eksklusibong pinsala para sa mga atleta na nagpapahagis. Para sa mga taong hindi gumagawa ng paulit-ulit na paghahagis sa itaas, ang nasirang UCL ay bihirang magdulot ng mga problema sa pang-araw-araw na buhay, dahil ang karaniwang mga gawain ay hindi nagbibigay ng stress sa ligamento gaya ng ginagawa ng pagpapahagis.

Mga maitutulong namin dito

Ang tamang gamutan ay nakadepende sa kung gaano kaganda ang pinsala sa ligamento, at pati na rin kung kailangan mo bang bumalik sa pagtatasa ng mataas na antas ng paghahagis.

Ang hindi pampasurgery na gamutan ang unang pinipili para sa bahagyang o mababang antas ng pagputol, at para sa sinumang hindi kailangang maghagis nang kompetitibo. Ito ay nangangahulugan ng panahon ng pahinga mula sa paghahagis, pagkatapos ay isang maingat na yugto-yugto na programa ng rehabilitasyon na muling nagtatayo ng lakas sa forearms, balikat, at core, nagwawasto ng mekaniks ng paghahagis, at dala ka pabalik sa paghahagis nang dahan-dahan sa pamamagitan ng isang istrukturadong "programa ng paghahagis." Ang mga injeksyon ng mga sangkap tulad ng platelet-rich plasma (PRP) ay minsan inaalok upang hikayatin ang paggaling, ngunit ang ebidensya na tumutulong sila ay patuloy na hindi tiyak.

Ang pampasurgery ay itinuturing kapag ang ligamento ay ganap na naputol, o kapag ang magandang rehabilitasyon ay hindi nagbigay-daan sa isang dedikadong manlalaro na bumalik sa mound. Mayroong dalawang pangunahing operasyon:

  • UCL reconstruction ("Tommy John surgery"). Ang nasirang ligamento ay muling binubuo gamit ang tendon graft, karaniwang kinukuha mula sa iyong sariling forearm o binti, inilalagay sa maliit na buto na mga butas upang muling lumikha ng bagong, matibay na ligamento. Ito ang matagal nang itinatag, patunay na operasyon para sa mga manlalaro.
  • UCL repair with an internal brace. Sa mga piniling mas batang atleta na ang ligamento ay malinis na naputol mula sa buto sa isang dulo (imbes na magulo sa buong haba nito), ang doktor ay maaaring tahiin ang ligamento pabalik at patibayin ito ng isang matibay na tape. Ito ay karaniwang nagbibigay-daan sa mas mabilis na pagbabalik sa paghahagis, at ito ay nakalaan lamang para sa tamang uri ng pagputol.

Sa parehong operasyon, sinisiyasat din ng doktor ang nerbiyos sa loob ng siko at pinoprotektahan o nililipat ito kung ito ay napapabigat.

Ano ang inaasahan

Para sa karamihan ng mga manlalaro na naglalaro ng paghahagis at mayroong operasyon, ang prognosis ay tunay na maganda: ang malaking karamihan ay bumabalik sa kanilang dating antas ng paghahagis, bagaman nangangailangan ito ng pasensya. Ang rekonstruksyon (Tommy John) ay karaniwang nangangahulugan ng isang hakbang-hakbang na paggaling sa loob ng humigit-kumulang isang taon o higit pa bago makapaglaro nang kompetitibo, habang ang pag-aayos gamit ang internal brace sa angkop na pasyente ay maaaring mabilisan. Sa anumang paraan, ang pagbabalik ay pinapagana ng isang mahaba at estrukturadong programa ng rehabilitasyon, hindi lamang ng operasyon; ang pagmadali sa pagbabalik ang pangunahing dahilan ng mga pagkabigo.

Ang paggaling ay hindi garantisadong magkapareho sa lahat: may maliit na bilang ng mga atleta na hindi bumabalik sa parehong antas, at ang mga sintomas ng nerbiyos o ang graft ay minsan ay nangangailangan ng patuloy na pag-aalaga. Ngunit sa malinaw na diagnosis, ang tamang pagpili ng paggamot, at komitido sa rehabilitasyon, ang mga resulta ng pinsalang ito ay isa sa pinakamagagandang resulta sa sports surgery.

Kailan kumonsulta sa doktor

  • Pain sa loob ng siko kapag nagtatayo, lalo na kung paulit-ulit ito o lumalala sa loob ng isang season.
  • Pagbaba ng bilis, katumpakan, o tibay sa pagtatayo na hindi nawawala kahit pahinga.
  • Biglaang "pop" o matulis na sakit sa loob ng siko habang nagtatayo, pagkatapos nito ay pakiramdam ng kahinaan o kawalan ng katatagan ng braso.
  • Pagkadama ng kawalan ng pakiramdam, pangangati, o kahinaan sa anghas at maliit na daliri.
  • Pain sa loob ng siko sa isang batang o lumalaking manlalaro: ang growth plate ng bata ay maaaring masaktan dahil sa parehong stress ng pagtatayo at nangangailangan ng agad na pagsusuri.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International


Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees


Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.