Ulnar Collateral Ligament Injuries Of The Elbow - Upswing Health

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Ulnar Collateral Ligament Injuries of the Elbow Treatment Causes, Symptoms & Treatment

Ulnar collateral ligament injuries affect the inner elbow, commonly in athletes who perform repetitive throwing motions. They cause pain, instability, and reduced performance. Treatment ranges from rest and physical therapy to surgical reconstruction, often called Tommy John surgery, depending on injury severity.

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• Overview
• Causes
• Symptoms
• When to see a doctor
• Non-operative treatment
• Surgical Treatment
• Recovery

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Overview

Ulnar collateral ligament (UCL) injuries happen when the ligament on the inner side of the elbow is damaged. The UCL is a strong band of tissue that connects the upper arm bone to one of the forearm bones. It helps keep the elbow stable, especially during throwing or when the arm is lifted overhead. Injury severity can range from mild strain to complete rupture and is classified into three grades.

• Grade I: The UCL is strained but not stretched or torn, causing pain and mild discomfort.
• Grade II: The UCL is stretched and weakened but remains intact.
• Grade III: The UCL is fully torn and can no longer stabilize the elbow joint.

What causes Ulnar Collateral Ligament Injuries of the Elbow?

Ulnar collateral ligament (UCL) injuries in the elbow often happen when the ligament is put under a lot of stress from repeated throwing, such as pitching a baseball. Most of the time, the injury develops slowly from overuse, but it can also happen suddenly during a single hard throw.

• How the Injury Occurs: Excessive repetitive stress or a single high-force throw overloads the inner elbow ligament beyond its tolerance.
• Common Everyday Causes: Heavy lifting, repetitive arm use, or falls on an outstretched hand can strain the UCL.

UCL injuries are common in these sports:

• Baseball: Repeated pitching places high valgus stress on the elbow.
• Gymnastics: Weight-bearing on the arms increases elbow strain.
• Javelin: Forceful overhead throwing stresses the UCL.
• Softball: Frequent throwing motions load the inner elbow.
• Tennis: Repetitive serves and overhead shots stress the ligament.

UCL injuries can be prevented by warming up properly, focusing on using correct throwing mechanics, and avoiding overthrowing by limiting the number of throws completed per day or week.

Symptoms

You may be experiencing an ulnar collateral ligament injury if you have pain on the inner side of the elbow that interferes with normal throwing motions. Early on, the pain is usually felt only while throwing. Over time, it may worsen and become constant, even during everyday activities. Pain related to a UCL injury is often most intense during the forward phase of throwing, just before releasing the ball.

In some cases, a sudden popping sensation followed by sharp pain may occur after a single throw, which often indicates a more severe tear. You may also notice tingling or numbness in the ring and pinky fingers. This typically happens when the nearby ulnar nerve becomes irritated or injured.

When to see a doctor

If you notice symptoms of an ulnar collateral ligament injury, it’s important to schedule an appointment with an orthopedic specialist. Ignoring minor injuries can allow them to worsen, potentially resulting in severe tears and elbow instability.

During the exam, your doctor will check for pain on the inner side of the elbow while gently moving and stretching your arm. The doctor may also perform a valgus stress test, which means carefully pushing the elbow outward to see if the joint feels loose or unstable. 

This helps show whether the ligament is injured. To confirm the diagnosis and see how severe the injury is, your doctor may recommend imaging tests such as:

• X-rays to rule out bone involvement
• MRI to assess the grade and extent of the ligament tear

Non-operative treatment

If the injury is classified as a grade I or grade II UCL tear, meaning the ligament is not completely torn, it will often heal without surgical intervention. Conservative treatment options for ulnar collateral ligament injuries include:

• Resting from throwing activities to allow the ligament to recover
• Non-steroidal anti-inflammatory medications (NSAIDs) to reduce pain and swelling
• Icing the affected area several times a day to manage inflammation
• Gentle stretching of the arm to maintain flexibility and prevent stiffness
• Working on proper throwing mechanics to reduce stress on the ligament and prevent future injuries

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

UCL

Surgical Treatment

If you have a grade III injury or tear of the ulnar collateral ligament, you may want to consider surgery to repair it. This operation is called Tommy John surgery, or ulnar collateral ligament reconstruction surgery. During the procedure, a graft (a piece of tendon from a cadaver or from another area in your body, like your forearm) is used to replace the torn ulnar collateral ligament. Your surgeon will drill small holes in the humerus and the ulna, through which the graft will be threaded and then secured to the bone.

Recovery

Recovery time varies depending on the severity of the UCL injury. For injuries treated without surgery, healing may take anywhere from a few weeks to several months. Full recovery after Tommy John surgery typically requires about one year, though some athletes may need up to two years before returning to their previous level of performance.

Following your orthopedic specialist’s instructions carefully is essential for proper healing. You can resume sports or throwing activities once you have regained a full range of motion, strength, and can perform movements without pain.

Reviewed By

Jay Kimmel

Dr. Jay Kimmel is a board-certified orthopedic surgeon specializing in sports medicine, arthroscopic surgery, and shoulder and knee disorders. He completed his orthopedic training at New York-Presbyterian/Columbia University Medical Center and a Sports Medicine Fellowship at Temple University.

Dr. Kimmel previously served as the Director of the Connecticut Sports Medicine Institute at Saint Francis Hospital and has held faculty appointments as Clinical Assistant Professor in the Departments of Orthopedics and Family Medicine at the University of Connecticut. He has extensive experience caring for athletes as a team physician for high school and collegiate programs and continues to teach in the athletic training departments at Westfield State University and Springfield College.

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Frequently Asked Questions

Can a UCL injury heal without surgery?

Yes, mild to moderate UCL injuries often heal fully with rest, therapy, and proper mechanics.

Is Tommy John surgery successful?

Yes, most athletes return to their previous level of performance within a year.

Can I prevent UCL injuries?

Absolutely, warming up, using correct throwing techniques, and limiting overuse greatly reduce risk.

Will I regain full motion after a UCL injury?

With proper treatment and rehab, most patients recover full elbow movement and strength.

Can I play sports again after a UCL tear?

Yes, once cleared by your doctor, athletes often return to play safely without pain.

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