Scott Webb (Host): Today, we're discussing platelet-rich plasma (PRP) for the treatment of ulnar collateral ligament injuries (UCL injuries) with Dr. Brian Polsky. He's an orthopedic surgeon and sports medicine specialist with OACM. And along the way, we'll discuss the decision by Baltimore Oriole's third baseman, Jordan Westburg, to opt for PRP over surgery for his UCL injury.

 Welcome to A Bone to Fix from Orthopedic Associates of Central Maryland Division. I'm Scott Webb, and I've got A Bone to Fix with you. Brian, it's nice to have you here today. We're going to talk about PRP in sports medicine, and we'll say what that is, of course, platelet-rich plasma therapy, PRP. Easier way to say that. And I want to talk to you a little bit about Baltimore Oriole's third baseman, Jordan Westberg. I know that he and his team opted for PRP instead of surgery for his partially torn UCL, ulnar collateral ligament. We'll probably abbreviate that as UCL as well in his right elbow.

So in reference to that, and just in general for folks, since you're the expert here, let's just talk a little bit about the UCL, you know, what is it. Is a partial tear, like, dramatically better than a full tear? Just kind of give us a foundation here about the UCL, and then we'll talk some more about PRP.

Dr. M. Brian Polsky: You know, what you're talking about is his throwing arm, okay? You know, a ligament, just to back up a little bit for real basics, a ligament is a structure that connects two bones, okay? So, a ligament is a static structure, as opposed to like a tendon that connects a muscle to a bone, that's considered a dynamic structure, okay? So, you know, when you put a stress on a static structure, it can be injured depending on the amount of stress on that structure. And so, the ulnar collateral ligament, the UCL, is the ligament that essentially connects the two bones on the inside of the elbow that receives the most force when throwing. So, a ligament, think of it like a really, really, really strong rubber band.

Host: Okay. That helps. Yeah.

Dr. M. Brian Polsky: And ,, you know, it has fibers. And, you know, it connects the two bones. And if someone is throwing and throwing and throwing, and that rubber band is getting stretched and stretched and stretched, a few of those fibers can give way. That is considered a partial tear. So, a complete tear, obviously, is when the complete rubber band snaps, okay? That is instantly a, you know, season-ending injury, and that requires surgical repair.

Host: Right.

Dr. M. Brian Polsky: So, a partial tear varies greatly from 1% or 2% or 3% of the ligament to 70% or 80% or 90% of the ligament. And those are obviously very different.

Host: Yeah. I'm with you. I'm kind of picturing it in my head. I wish we had some diagrams.

Dr. M. Brian Polsky: Yeah. But yeah, you can—

Host: I gotcha. I'm with you.

Dr. M. Brian Polsky: Picture a rubber band that has a tiny little partial tear or a rubber band that's hanging on by a thread, right?

Host: Of course. Right.

Dr. M. Brian Polsky: So, you know, I have not had the opportunity to see his MRI, but my assumption is that he has a fairly small partial tear, because that would lend itself to the possibility of healing with PRP.

Host: Gotcha.

Dr. M. Brian Polsky: Platelet-rich plasma. And if we want, you know, talk about that, it's essentially drawing blood from a person, spinning that blood down to the, I guess, what you would call the healing factors of blood, the platelets. And the platelet-rich plasma is the healing factors of blood. And then, the theory is or has been that you inject it into an area that needs healing. And it does its magic and heals

Host: And I know that PRP is thought to help in the healing of UCLs. Maybe you can explain that, like how does that work, the injection part and the healing part, if you can.

Dr. M. Brian Polsky: Right. You know, essentially, they draw his blood, spin it down to the healing factors, and then they inject that directly into the injured area, the partial tear. The UCL's fairly superficial. So, it can be done, you know, directly or sometimes with ultrasound guidance to get it into the right spot. And then, you have to give that time to go through the healing process of repairing those torn fibers.

And so, there's a few phases. The first phase is kind of the active phase where the injection actually causes a bit of an inflammatory reaction. And then, you know, as weeks go by, those fibers can start to heal. And then, once they're healed, he goes through a rehab protocol, range of motion, strength. And then, once that's complete, he can get into potentially throwing again. That's usually over probably an eight- to 12-week period.

Host: Okay. Yeah. I'm wondering when we think about who's a good candidate, right? We're talking about this player, Westberg in particular. But in general for the masses, if you will, like when we think about comparing PRP, I guess, or considering the Tommy John surgery, which so many of us have heard of, you know, who's a good candidate for PRP?

Dr. M. Brian Polsky: It depends on the injury, it depends on the patient, and it depends on the patient's expectations, right? So, you know, a lot of the patients I deal with, if they have ulnar collateral ligament injury, they're not necessarily professional pitchers or throwers.

Host: Of course. Right. Yeah.

Dr. M. Brian Polsky: They might be weekend warriors or even high school or college. And so, you know, they probably have the same expectations that they want to get back to a high level. You know, again, it really, really depends on what the MRI and the treating physician decide is the injury to the UCL, you know, literally what the percentage is, 2% or 3% or 4% or 5%, 40%, 50%, 60%. You really, really have to make that distinction, because the PRP is going to potentially be successful in the much smaller partial tears.

Host: Yes. It does seem that Tommy John was the gold standard, was the go-to at one time. But now, as you're saying, you know, the partial tears, especially the smaller percentage tears, it sounds like PRP could be pretty success.

Dr. M. Brian Polsky: It can, and there's been some scientific evidence that it is efficacious. There's not a whole lot of real definitive papers on it. And so, I would say technically the jury is still a bit out, but there is enough on the safety profile and enough on some outcomes that it is a reasonable thing to consider.

Host: Yeah. And I know that he—we're talking here in 2026—he had the PRP injection administered on February 20th, and they were saying estimates were that he would be back something like May 2026. Does that sound about right to you in terms of the, you know, realistic timelines for the healing needed for a UCL tear?

Dr. M. Brian Polsky: Yeah, probably so. You know, eight to 12 weeks. And again, it depends on even still the severity of the tear. So like, if you're using a PRP injection for a 5% tear, you know, three months is probably pretty reasonable. If you're trying to use PRP for a 30% or 40% tear, you're probably going to wait a little longer. And there's probably a higher risk of it not working.

Host: So, just thinking about like throwing programs, be it if you're a third basema or pitchers or pickle ballers or bowlers or whatever folks are, right? Like in terms of benchmarks, how do we know when we might be ready to either return—in his case, to competitive pitching or fielding—or for us, getting back on the pickleball court or whatever it might be?

Dr. M. Brian Polsky: Well, and there's certainly some basic ways to evaluate that. Certainly, physical examination by the physician. You can stress that ligament and assess pain and stability. So, you know, a partially torn ligament tends to feel slightly loose. It'll have a good endpoint, right? You know, it's not ruptured, but it might feel slightly loose.

If it's healing, then that rubber band is essentially almost kind of tightening up. And it's going to give more stability and you can feel that on a good physical exam. And then, certainly tenderness and pain. And then, there are other provocative tests to, you know, almost recreate throwing and see how that feels. And so, you're going to follow those physical exams through the course of the healing process to assess how it's working.

Host: And I am sure like a lot of things with athletes, especially, you know, professional athletes, competitive athletes, whether it's an ACL or, here, we're talking about UCL, I'm sure there's a mental side of it. Maybe psychological, but mental side of it of, just like the confidence factor. Like, even some athletes might be told you're ready, but they have to know they're ready perhaps, right?

Dr. M. Brian Polsky: That's a very, very good point. And, you know, the ulnar collateral ligament of the elbow is kind of like the ACL of the knee.

Host: Right. Yeah.

Dr. M. Brian Polsky: And it's very accurate. I mean, I do tons of these. And, you know, a lot of times, the knee or the elbow will feel rock solid, feels great, no pain, full strength, and yet they're still very hesitant. And that's common. In certain folks, that takes some practice. And it takes a lot of work to overcome that, to realize that they are essentially back to—at least a back to normal, not super, but normal.

Host: Yeah. To be both physically and mentally, you know, ready for action on whatever level. Wondering, Brian, are there like some special considerations? Like, does it matter whether you're a third baseman or a pitcher or a bowler, like, is ready ready? Or is it possible to be more ready than perhaps someone else?

Dr. M. Brian Polsky: Well, I mean, I think what you're getting at is that the act of throwing is a very, very abnormal thing. You know, human shoulder/elbow, it was never meant to throw 80 or 90 miles an hour. And it's just not really built for that. So, you know, getting back to that takes longer. And you mentioned just, for comparison's sake, you mentioned bowling. That's obviously very, very different.

Host: Right. Than throwing. Yeah.

Dr. M. Brian Polsky: There's certain things like bowler's elbow, but it's not nearly the amount on a, you know, a pitcher or a third baseman or outfielder. So, they would probably be able to return to their sport more quickly.

Host: Yeah. I see what you mean. So when we think about now where science and medicine and all this is so amazing, so, you know, for partial tears of the UCL, PRP is an option. And it may or may not be successful or there might be degrees of success. At what point, Brian, do you recommend then moving back to surgical reconstruction for a Tommy John? Is it just, if symptoms don't improve? Like, how would an athlete or the team with that athlete, how would they know?

Dr. M. Brian Polsky: And you're right. It is not a hundred percent. What they're really trying to do and hoping is that this—obviously because a surgical procedure is a nine to 12 months to get back to, you know, a very, very high level of throwing; and sometimes longer and sometimes never.

So, to answer your question, you know, you certainly want to give it at least three or four months. Some of it depends on the position. If someone is a first baseman or second baseman, they might be able to get back to that quicker. But, you know, essentially, you're going to probably call it a failure at four or five months, if they really were still having a lot of pain and can't throw. You would certainly get new MRIs to assess that ligament to see if there's been healing. I mean, if it was a 10-15% tear and you injected it and you went through the whole process and they went through rehab and had pain at three or four months and you got a new MRI, and it was still 10 or 15% torn, that would be considered a failure.

Host: Right. Time to talk Tommy John, which would be a separate podcast. Yeah, wondering Brian, like when we think about short-term performance limitations, like might a player experience after the non-operative UCL treatment that we're talking about here, the PRP, would it be reasonable to have some, you know, limitations? And again, like, maybe how long might we deal with those before we start thinking that maybe, you know, that it was a failure or wasn't quite the total success we were hoping for? And maybe start talking Tommy John.

Dr. M. Brian Polsky: Still probably in the three- to six-month range. I mean, you know, if someone at three or four months was having a good result, they're starting their throwing program, really not having pain, they could potentially make it back out onto the field. And you might even have minor setbacks, that may not even necessarily have to do with the PRP. I mean, you can develop shoulder pain or tendonitis.

Host: Could be something else, right? Yeah.

Dr. M. Brian Polsky: That might set them back. But if it specifically continues to be the ulnar collateral ligament that is tender or limiting them, you know, month after month, they make it back for a couple weeks, it starts hurting again, they shut them down, they make it back, you know, at some point in time, you have to probably call that a failure.

Host: Yeah, call it a day. Well, I have so many more questions for you. I want to talk Tommy John, I want to talk a whole bunch of other things. But for today, you know, in consideration of listeners and their attention spans, final thoughts, takeaways when we're talking about the UCL in this case with Jordan Westberg, but folks in general who have partially torn ulnar collateral ligament, UCL and PRP as an option, what are your final thoughts?

Dr. M. Brian Polsky: I think it's exciting. You know, I think we have work to do on good research on PRP. But from what I've seen and read and, in even in my hands, have used, it's an exciting tool now that I can use that's non-surgical. It's a very reasonable thing to consider in situations that we discussed. And I would encourage people to mention it or, you know, even seek it to see if it's a possibility for them.

Host: Right. Yeah. Especially if you're not third baseman for the Baltimore Orioles and you're just trying to get back to some stuff that you love and it's a small percentage tear, as you're saying, like it feels like it's worth a conversation and maybe worth trying, giving that a shot if surgery is not, you know, at the top of your to-do list. So, hopefully, we'll get to talk about some of those other things in the future. But for today, thanks so much.

Dr. M. Brian Polsky: Yeah. That was wonderful. I appreciate your time, Scott. Thank you.

Host: And if you suffered a sports or activity-related injury, schedule an appointment with one of our sports medicine specialists today at mdbonedocs.com. Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb, and that was A Bone That's Fixed.