Key Points about Ulnar Collateral Ligament (UCL) Injury


  • A UCL tear can be classified from grade 1 (stretched ligament) to grade 3 (complete tear).
  • An acute UCL injury is caused by a sudden incident that causes the ligament to tear. A chronic UCL injury occurs over time as repetitive movements cause micro-tears or a rupture.
  • Symptoms of a UCL injury include pain on the inside of the elbow while throwing a ball in a sport such as baseball, or weakness, tingling, or numbness around your pinky or ring fingers.
  • Your doctor can diagnose a UCL injury during a clinic visit from a physical exam and a valgus stress test. In some cases, an MRI is also necessary.
  • While many people can be treated with conservative methods, surgery may be required. Tommy John’s surgery involves reattaching the ligament to the bone.
  • It might take as long as a year to return to your sport if the injury was severe.


An ulnar collateral ligament injury also referred to as a UCL injury, is a common injury to the inside of the elbow caused by repeated stress due to overhead movement.

The UCL is a strong band of tissue that holds the bones together and controls movement on the inside of the elbow.

UCL injuries are commonplace in sports that involve throwing an object such as baseball, shot put, or softball.

A UCL injury is classified as a sprain and graded from grade 1 to 3.

  • Grade 1 sprains — There is not a tear, but the ligament is stretched.
  • Grade 2 sprains — The ligament is stretched, and it could be partially torn.
  • Grade 3 sprains — Complete ligament tear.

Ulnar Collateral Ligament (UCL) Injury Causes

UCL injuries result from both acute and chronic injuries. An acute UCL injury occurs when excess stress placed on the elbow at one time, causing it to tear. Typically, you can hear a popping sound when experiencing an acute UCL injury. A chronic UCL injury occurs from repeated stress on a throwing arm, causing it to stretch, tear, or rupture.

Chronic UCL injuries are more common than acute UCL injuries.

An acute UCL injury can be caused by falling on an outstretched hand or an accident at work.

Ulnar Collateral Ligament (UCL) Injury Symptoms

The most common sign of a UCL injury is a sudden pop on the inside of the elbow, which impairs your ability to throw.

Other symptoms of a UCL injury include:

  • Pain on the inside of the elbow after an overhead activity or repeatedly throwing.
  • Pain as the arm is accelerating forward to throw an object.
  • Weakness, tingling, or numbness around pinky or ring fingers.

While UCL injuries affect your ability to participate in your sport, it is not likely to affect your daily routine that does not require throwing.

Ulnar Collateral Ligament (UCL) Injury Complications

If left untreated or not treated appropriately, a chronic UCL injury can cause disabling pain and instability and as well as reduced pinch strength.

Ulnar Collateral Ligament (UCL) Injury Risk Factors

People who play sports that require overhead movements are most likely to develop an ulnar collateral ligament injury.

Ulnar Collateral Ligament (UCL) Injury Prevention

UCL injuries can be prevented by following these guidelines:

  • Avoid throwing sidearm.
  • Do not pitch (softball or baseball) all year round.
  • Do not pitch with pain.
  • Enforce strict pitch counts if throwing over 85 mph.
  • Learn proper pitching techniques.

Ulnar Collateral Ligament (UCL) Injury Diagnosis

Your orthopedist or sports medicine doctor can diagnose a UCL injury. During your clinic visit, your doctor will perform a physical examination, take a full medical history, and perform a valgus stress test. A valgus stress test evaluates your elbow for instability. It is the best way to assess the UCL.

Your doctor may also order an MRI scan or X-ray to understand the severity of your injury or determine if you have a broken bone.

If the Valgus test is positive, and there is not a broken bone, your doctor may order an MR arthrogram where dye is injected into the elbow joint.

Ulnar Collateral Ligament (UCL) Injury Treatment

Your surgeon will develop a custom treatment plan for your case. Depending on the severity of your case, your surgeon will either treat it conservatively or surgically.  The dye makes the tear easier to see.

Conservative treatments for a UCL injury include:

  • Rest.
  • Ice.
  • Anti-inflammatory medication.
  • Physical therapy. Physical therapy can help strengthen the muscles around the elbow.
  • Brace or sling for acute UCL injuries. Immobilizing the elbow can reduce stress on the elbow.

When the ligament is completely torn off the bone or pain persists after conservative treatment; surgery may be necessary to repair or reconstruct the tear. The operation is called Tommy John's surgery. During surgery, your orthopedic surgeon will make an incision on the inside of the elbow and reattach it to the bone.

When to Seek Care

If you experience an acute UCL injury (a sudden pop), visit your doctor right away. If you feel pain in the elbow, schedule an appointment with your doctor to evaluate your treatment options. Recovery is quicker if you begin treatment earlier.

Next Steps

If you had surgery to treat your UCL injury, recovery could take as long as a few months, depending upon the range of motion you need in the elbow. During the recovery process, you will need physical therapy to strengthen the elbow. Rehabilitation can take more than a year.

It is essential to follow your doctor's recovery instructions and not return to your sport too soon.

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