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Ulnar Collateral Ligament (UCL) Injury

Ulnar Collateral Ligament Injury (UCL Injury) Overview

The ulnar collateral ligament (UCL) is a thick, triangular section of tissue that runs from the inner side of the humerus to the inner side of the ulna. The UCL is designed to withstand a large amount of stress as it stabilizes the elbow joint. Athletes and other active individuals may experience an ulnar collateral ligament tear from repetitive overhead movements.

The UCL is commonly injured in throwing activities or after an elbow dislocation, typically from a fall on an outstretched arm. Once the ligament becomes stretched, frayed or torn from overuse, a patient experiences an elevated risk of a UCL injury. After months, possibly years, the microtrauma can lead to an ulnar collateral ligament tear ranging from a small stretch to a full tear.

There are three classifications for a UCL injury:

  • First-degree sprain: Ligament is strained but not stretched, leading to elbow pain
  • Second-degree sprain: Ligament is stretched, leading to increased elbow pain
  • Third-degree sprain: Ligament is torn or ruptured, leading to loss of all elbow function

Symptoms of a UCL Injury

Elbow pain along the inside of the joint is the main symptom in many patients. Numbness, swelling, bruising and elbow instability are also quite common. A popping or tearing sensation may be experienced at the time of injury. Depending on the severity of the UCL injury, athletes may lose the ability to throw at full speed. In many atheletes, the pain develops gradually over time without a specific injury episode.

Diagnosis of a UCL Injury

Dr. Waterman will perform a medical review and physical examination of the shoulder to reach a diagnosis. He will perform specific tests to determine areas of tightness and looseness. A valgus stress test is a common test performed to test the elbow for stability. During this test, Dr. Waterman will place pressure toward the inside of the elbow as the joint is moved in order to observe gapping of the joint and reproduction of medial elbow pain. A series of X-rays will typically be performed to look for bone spurs or other bone abnormalities. An MRI is performed in many cases to diagnose the extent of the ulnar collateral ligament tear.
Treatment of a UCL Injury

The treatment of a UCL injury depends on patient’s age, patient’s activity level and extent of the ulnar collateral ligament tear. Dr. Waterman will explain all available treatments at the time of consultation.


A mild UCL injury is typically treated with non-surgical measures such as rest, ice, anti-inflammatory medications and a physical therapy recovery program.Dr. Waterman may also recommend the athletic player’s mechanics be evaluated and corrected, if needed.


If the UCL injury is too severe or doesn’t respond to non-surgical treatment,Dr. Waterman may recommend surgery. Many cases of an ulnar collateral ligament tear are treated using an arthroscopic reconstruction procedure. Known as the “Tommy John” procedure,Dr. Waterman will use a patient’s own forearm tissue to reconstruct the damaged ligament. In cases where a patient’s tissue cannot be used, a donor tissue (allograft) will be utilized.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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