SEEHAFER: Demystifying Shohei Ohtani's UCL Sprain

Yahoo! Sports’ Jeff Passan reported Tuesday night that the physical exam of Los Angeles Angels do-it-all superstar Shohei Ohtani revealed a first-degree sprain of his right UCL. While at first glance these findings may sound alarming, in fact, things could be much, much worse.

The ulnar collateral ligament — UCL, though it’s also sometimes referred to as the medial collateral ligament, or MCL, of the elbow, but most call it the UCL to prevent confusion with the MCL of the knee — is a strong ligament located on the inner, or medial, elbow.

The triangular-shaped ligament is comprised of three distinct portions that all run from the humerus of the upper arm to the ulna of the forearm and its main function is to provide stability to the medial elbow against valgus stresses.

A valgus stress is placed on the medial elbow every time a throwing motion is completed, which over an extended period of time, can lead to an accumulation of microtrauma within the UCL. In a worst-case scenario, the microtrauma builds to a point where the entire structure fails, which would require Tommy John surgery, otherwise known as UCL reconstruction, to fix.

A complete rupture of a ligament is classified as a grade 3 sprain — the highest and most severe grade.

Luckily for Ohtani and the Angels, the star only suffered a grade 1 sprain of his UCL. A grade 1 sprain is essentially a slight overstretch of the ligament, with very little or no tearing. A grade 2 sprain would be if the ligament was overstretched and torn, but not to the point where the entire structure failed. Grade 1 sprains typically heal on their own within a matter of a few weeks, whereas grade 2 and 3 sprains can take months.

However, according to Passan and the report provided to him, Ohtani received a PRP (platelet-rich plasma) injection on Oct. 20 to help address his UCL sprain and that he “will be most likely available to start his throwing program approximately one month from his [injection]” or approximately Nov. 20.

Platelet-rich plasma is gathered by spinning a vial of blood taken from the individual at a rapid velocity in order to separate the red blood cells from the plasma — essentially, everything in the blood that isn’t a red blood cell. The plasma is then injected into the joint, in Ohtani’s case the right elbow, in order to promote healing and decrease inflammation via the platelets, a type of specialized blood cell.

Elbow injuries typically aren’t anything to mess with, but Ohtani’s could be much, much worse

It’s standard protocol to hold a player out from throwing for a month or so after receiving a PRP injection as that amount of time allows for the injection to take effect and for proper healing to occur. Passan noted that Ohtani had reportedly been spotted throwing in Japan recently.

Additionally, Passan reported that the physical exam revealed “a small free body floating” in his right elbow.

A “free body”, also referred to as a loose body, is typically a small piece of cartilage and/or bone that has become dislodged and is floating within the synovial fluid of the joint. These loose bodies can sometimes be painful and restrict range of motion, but may also go unnoticed. If painful, loose bodies are often treated conservatively with non-steroidal anti-inflammatory (NSAID) medications and/or physical therapy, but can also be removed arthroscopically if other treatment options fail to provide relief.

The report stated that Ohtani would be “able to continue full baseball participation with a sufficient elbow care program,” which usually consists of decreasing the number of pitches/throws in each session and gradually increasing the reps and throw distance as pain allows. Ice, rest and NSAID medication are indicated as needed.

In all, Ohtani’s injury shouldn’t be too concerning given the star and Angels manage it properly. While it is true that improper management of a grade 1 UCL sprain could ultimately lead to rupture and, thus, Tommy John surgery, that outcome shouldn’t arise as long as the PRP injection was given enough time to take effect and Ohtani doesn’t push through a significant amount of pain.

Elbow injuries typically aren’t anything to mess with, but Ohtani’s could be much, much worse.


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