UCL Injury Treatment Options

The ulnar collateral ligament, or UCL, is a strong band of tissue on the inside of the elbow that connects the upper arm bone to one of the bones in the forearm. Its main job is to keep the elbow stable, especially during motions that put stress on the joint, like throwing. The UCL is especially important for athletes who play sports such as baseball, softball, tennis, and javelin. When the ligament is healthy, it prevents the elbow from moving too far inward. When it is injured, the elbow can become painful and unstable.

What causes a UCL injury?

A UCL injury can happen slowly over time or suddenly in one motion. The most common cause is overuse. Repeated throwing or overhead activity puts a lot of stress on the inside of the elbow, and over time the ligament may stretch or tear. This is why pitchers and other throwing athletes are at high risk. A UCL injury can also happen from a single traumatic event, such as an especially forceful throw, a fall onto the arm, or an elbow dislocation.

Risks include using poor throwing mechanics, not resting enough between games, or not having strong shoulder and core muscles can all increase the risk. Younger athletes may also be more vulnerable if they throw too much while their bodies are still growing.

What are the types of UCL injuries?

There are different levels of UCL injuries.

• A mild injury means the ligament is stretched but not torn. This can cause discomfort but may not lead to full instability.
• A partial tear means some of the fibers are damaged, often leading to pain, weakness, or loss of control when throwing.
• A complete tear means the ligament is fully torn, leaving the elbow unstable and usually making it impossible to throw at a high level. Sometimes, the ligament can even pull a small piece of bone with it, which is called an avulsion.

What are the symptoms of a UCL injury?

When someone has a UCL injury, they often feel pain on the inside of the elbow, especially while throwing.

• Some people describe hearing or feeling a “pop” at the time of injury.
• Others notice their throwing speed or accuracy getting worse over time.

How is a UCL injury diagnosed?

To diagnose the injury, a doctor will examine the elbow, often putting gentle pressure on it to check for looseness or pain. Imaging tests like an MRI are usually done to see the extent of the damage, and sometimes an ultrasound is used to look at the ligament while the elbow is moving.

What are the treatment options?

Treatment for a UCL injury depends on how bad the injury is, what activities the person wants to return to, and how much stress they put on their elbow.

For mild injuries, non-surgical treatment is usually the first step.

• This involves rest and avoiding activities that strain the elbow, along with ice and anti-inflammatory medicine to help reduce pain and swelling.
• Physical therapy is an important part of treatment, focusing on strengthening the muscles in the forearm, shoulder, and core to support the elbow.
• Braces may be used to protect the joint
• Platelet-rich Plasma Injections may be recommended which use components of the patient’s own blood to encourage healing.

Many athletes with partial tears can recover and return to activity after several months of rehab.

Complete tears of the ligament, or if non-surgical treatments do not provide enough relief, surgery may be recommended. The most common surgery is called UCL reconstruction, also known as Tommy John surgery. In this procedure, the damaged ligament is replaced with a tendon taken from another part of the body or from a donor. The new tendon is secured in place to act like a healthy ligament. Recovery after Tommy John surgery takes time—often around a year—but many athletes are able to return to their sport once they complete a full rehabilitation program.

UCL Repair: In certain cases, a UCL repair may be an option. Instead of replacing the ligament, the surgeon reattaches and reinforces it, sometimes using a special “internal brace” to make it stronger. This approach may allow for a quicker recovery compared to a full reconstruction, but it is only possible in certain types of injuries, usually when the ligament has torn cleanly from the bone and the tissue is otherwise healthy.

Deciding which treatment option is best depends on several factors, including the severity of the injury, the patient’s age, their level of competition, and their goals. For example, a professional pitcher with a complete tear will likely need surgery to get back to playing at the same level, while a recreational athlete with a mild or partial tear may do well with rest and therapy.

What is the recovery time?

Recovery time can range from a few months for mild injuries treated without surgery to a year or more for athletes who undergo reconstruction surgery. With the right treatment plan and rehabilitation, most people are able to return to their usual activities, and athletes often return to the sports they love. Advances in surgical techniques and rehabilitation have made outcomes better than ever, giving patients a high chance of getting back to full function.

If you are noticing pain on the inside of your elbow, a loss of strength, or a decline in your performance when throwing, it may be a sign of a UCL injury. The earlier you seek care, the more treatment options you will have and the better your results are likely to be. Dr. Brian Waterman, a board-certified and fellowship-trained orthopedic surgeon and sports medicine specialist in Winston-Salem, North Carolina, provides expert care for athletes and active individuals with UCL injuries. If you are struggling with elbow pain or suspect a ligament injury, schedule an appointment today to receive a personalized evaluation and treatment plan designed to help you recover and return to the activities you enjoy.