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Ulnar Collateral Ligament Reconstruction In Baseball Pitchers
Chapter 7-The Effect of Ulnar Collateral Ligament Reconstruction

Chapter 7

The Effect of Ulnar Collateral Ligament Reconstruction on Ulnar Nerve Damage Symptoms and Maximum Fastball Velocity in Baseball Pithers

Goal of Study

      My survey was sent out to 91 baseball players who have had ulnar collateral ligament reconstruction.  The questions aimed to assess the impact of surgery on the players ulnar nerve; whether it alleviated or created the pain.  Also, the study addresses the myth that UCL replacement will increase the velocity of the athletes fastball.

Survey Participants

     Twenty-six of the surveys were returned, however two of the athletes were catchers and thus were excluded from the data.  Of the pitchers, 19 of 24 (79.2%) had the surgery in college and 18 of 24 (75%) were in college at the time of the survey (Figure 17).  The average age at time of surgery was 20 years and 6 months, with an average follow-up of 1 year and 8 months.

Results

Ulnar Nerve Effects

     Seven of the twenty-four pitchers experienced ulnar nerve damage symptoms, numbness or tingling in the fourth and fifth finger, prior to surgery.  After surgery, only two of those seven continued to have this problem.  One players postoperative ulnar nerve damage symptoms disappeared without any extra treatment and one players symptoms went away with non-surgical treatment.  Only one athlete of the 17 (5.9%) who had not experienced the numbness or tingling prior to surgery experienced this problem after surgery, and it went away without treatment.  As seen in Figure 18, 3 of 24 (12.5%) pitchers who underwent UCL replacement experienced ulnar nerve damage indications after surgery, none of which persisted.

Fastball Velocity

      Twelve of the twenty-four pitchers (50.0%) stated that they were one hundred percent recovered from surgery.  For these twelve athletes, the maximum fastball velocity increased from 91.5 2.8 mph to 92.3 2.8 mph.  This fact can be deceiving, however, because one pitcher who had the surgery done in high school and is currently playing AA baseball increased from 88 to 97 mph.  When the twelve pitchers are viewed as individuals, 3 (25.0%) experienced an increase, 7 (58.3%) remained the same, and 2  (16.7%) decreased their maximum fastball velocity (Figure 19).  The average increase among the three who saw improvement was 4 mph and the average decrease among the two was 1 mph.   A paired t-test states that the change in velocity was not significant with
a 95% confidence level (p=0.3064).

Discussion

     In the past, the rate of ulnar nerve problems after surgery was as high as 21.1% (Conway et al. 1992).  Newer techniques allow surgeons to lessen the chance of damage, and my survey presented a 12.5% incidence of ulnar nerve injury.  Also, problems before surgery involving the ulnar nerve were resolved after surgery, with only one patient not immediately experiencing this result.  The surgerys ability to avoid ulnar nerve damage has decreased as modifications have been added.

      The maximum fastball velocity slightly increased according to the survey.  However, a majority of the athletes (58.3%) did not see a change and only one athlete had an increase or decrease of greater than two miles per hour.  The insignificance of the change, based on the t-test, shows that although the myth of increased velocity may not be true, the players are also not losing velocity after the surgery.

     This experiment presented many possible sources of error.  Surveys were sent to the college players through the coaches, and thus only successful surgeries were involved.  This research does not address the rate of surgical success, only the type of success noticed in players who return to competitive play.  The small sample number (n=24) may have led to percentages that were not indicative of the entire population of athletes who have had ulnar collateral ligament replacement surgery.  Finally, the players contributed fastball velocity data and thus the actual numbers may not be accurate. 

     Future research on this topic is needed.  A comparison of results seen in athletes who have undergone different techniques (docking procedure, bone anchors, etc.) should be done.  This survey asked the pitchers whether they had undergone an ulnar nerve transposition, and although the option I dont know was provided, I felt the athletes might have answered the question incorrectly.  The best way to examine the effect of ulnar nerve transposition would be to do the research through surgeons who could confirm the type of surgery performed.


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