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Ulnar Collateral Ligament (UCL) Injury - Elbow

The ulnar collateral ligament (UCL) of the elbow is a structure that is critical for elbow stability. The UCL is a triangular, thick section of tissue that maintains a healthy and normal valgus relationship between the arm bone (humerus) and the ulna (one of the bones found in the forearm). An ulnar collateral ligament injury can range from a mild stretch, to a full tear. An elbow ligament injury is usually the result of a sports injury that involves repetitive overuse associated with pitching or throwing. In most cases, it is the direct result of a hard, forceful throw as commonly seen among baseball pitchers. While a UCL injury can occur in isolation, it can also occur concurrently with an elbow dislocation.

Dr. Parikh will conduct a thorough physical examination and MRI of the eblow to assess wheter there is a UCL injury. This will allow him to view the soft tissue structures of the elbow, and based on his exam, he will be able to apply a grade to the elbow ligament injury. There are three clasifications for a UCL injury of the elbow: a first-degree sprain occurs when the ligament is strained without it becoming stretched. This strain leads to eblow pain. A second-degree sprain occurs when the ligament is stretched. While the patient will experience increased pain, especially with movement, the elbow can still function. A third-degree sprain occurs when the ligament has been torn or ruptured. An ulnar collaterall ligament tear results in an elbow that looses function all together.


Patients who sustain an ulnar collateral ligament (UCL) injury will experience elbow pain, numbness, and swelling. Elbow instability will also occur. Some patients suffering from an elbow ligament injury may have trouble gripping items with their hands. Athletes will experience a loss of control with throwing and thus will not be able to complete a throw at full speed or strength. When an UCL injury occurs, a pop or pulling sound can be heard.  All of these symptoms will range depending upon the severity of the injury. 



A mild ulnar collateral ligament injury will often resolve on its own with conservative treatment. This includes rest, ice, non-steroidal anti-inflammatory medications, and sometimes, therapy. Dr. Parikh will most likely place the arm in a cast or splint for a period of time in order to allow the ligament to heal properly and stay protected.


In high-level athletes, patients who have acute trauma associated with an ulnar colateral ligament tear, or for those who experience persistent elbow pain and elbow instability, a reconstruction surgery may be required. Ulnar colateral ligament tears and ruptures are treated using an arthroscopic surgical approach where the ligament is reconstructed using a soft tissue graft. This surgical technique, known as the "Tommy John" procedure, will use the patient's own tissue from the forearm because evidence-based research has shown that this particular tendon provides similar anatomical characteristics as the native footprint. Some patients may require an allograft (donor tissue). In acute circumstances where a larger portion of the ligament is damaged, a tendon transfer may be necessary.

Following ulnar collateral ligament surgery, patients are required to wear a cast for approximately 6 weeks after which moderate exercises and movements of the arm can occur. Physical therapy will be a progressive process that will initially focus on range of motion, and later, strengthening exercises. Most patients are able to return to their sporting activities in roughly 3-4 months following surgery.

Information obtain from