Article by Dr. Mark Cohen

Georgia Bulldog fans and alumni are feeling a lot of angst these days as they await word on the status of their star quarterback, Carson Beck. As you may know, Beck injured his elbow on a play in the SEC Championship game against Texas.  At the time of this publication, his playoff future is unknown. What is known, is the type of injury he suffered. You may have heard the acronyms MCL or UCL floating around during the banter on sports talk shows, which just means the quarterback injured the medial ligament of his elbow.

What is the UCL?

This structure stabilizes the elbow against forces pulling the forearm laterally (away) from the body.  One can think of the elbow as a simple hinge. The MCL is the internal support of that hinge closest to the body.  The MCL is critical for all activities related to throwing, which stresses the ligament.  Which brings us to the other sport you commonly hear about this injury — baseball. The MCL is the ligament that many baseball pitchers tear, commonly known as the “Tommy John” ligament that requires surgery.

The mechanism of injury

What is different about Carson’s injury is that it was directly related to a traumatic event.  His arm was hit while he attempted to throw a Hail Mary pass at the end of the first half.  In this setting, his ligament was normal before the play but was subjected to excessive tension because of the force of the hit. This is in direct contrast to baseball athletes. In pitchers, whether professional or little league, the ligament does not fail this way.  In pitchers, the ligament slowly breaks down over time.  When it finally tears, this is the last straw. The ligament is sick from repetitive stress over time.  You can liken it to a weakening shoelace — with frayed and irregular ends. As such, in pitchers, this deteriorating ligament is much less likely to be directly repairable; hence the need for the Tommy John surgery. This type of surgical intervention is essentially a reconstruction of the ligament where a tendon (the tissue that attaches muscle to bone) is used to replace and ultimately reinforce the ligament. 

When a normal, conceivably healthy, ligament such as Carson’s tears, the ligament does have healing potential on its own.  So, there is hope for Bulldog fans and alumni — it just depends on how severe his tear is.

Grading the severity of the tear

Doctors grade these acute or traumatic ligament tears on a 3-point scale through the use of MRIs and a physical exam. Type 1 tears are small internal tears or “sprains” of the ligament.  If Carson has a Type 1 injury, he may be able to play in the college playoffs. Type 2 tears involve partial failure of the ligament with some fibers remaining intact.  These injuries also have the capacity to heal on their own.  If Carson has a Type 2 tear, however, he will most likely be out for the remainder of the playoffs.  Ligament healing takes several months.  Type 3 tears, on the other hand, involve a complete failure of the ligament from one of the attachments, or a failure in the middle of the ligament.  The good news is that for many people who are not throwing athletes, the MCL can actually heal even in Type 3 tears, and surgery is often not needed.  However, in a college quarterback like Carson, surgery is often recommended if the ligament is pulled apart to ensure proper tension and stability of the elbow for future play. 

With all that being said, and few additional details being released about Carson’s condition — all is not lost for avid Bulldog fans. They still can have a glimmer of hope for their starting quarterback to return.