Ulnar Collateral Ligament (UCL) Injury

Understanding Ulnar Collateral Ligament (UCL) Injury

The ulnar collateral ligament (UCL) is a strong band on the inner side of the elbow that connects the humerus to the ulna. It resists the inward-bending (valgus) stress that occurs during the late cocking and acceleration phases of throwing.

UCL injuries range from sprains and partial tears to complete tears. Most occur gradually from repetitive throwing in baseball pitchers, javelin throwers, quarterbacks and volleyball players, although a fall on an outstretched arm can also tear the ligament. Athletes may feel a pop and notice pain on the inside of the elbow, reduced velocity, or numbness from irritation of the nearby ulnar nerve.

Many partial tears improve with rest from throwing, physical therapy and a gradual return-to-throwing program. Throwing athletes with complete tears or tears that do not improve may need UCL repair or reconstruction ("Tommy John" surgery).

Causes & Risk Factors

• Repetitive overhead throwing
• High pitch counts and insufficient rest
• A fall on an outstretched arm

Symptoms

Common signs and symptoms of UCL Injury include:

• Pain on the inner elbow when throwing
• A pop at the time of injury
• Loss of throwing velocity or control
• Tingling or numbness in the ring and small fingers

Treatment Options

Treatment for UCL Injury depends on the severity of your condition and may include:

• Rest from throwing, typically for about 6 to 12 weeks before re-examination
• Anti-inflammatory medications (steroid injections are generally avoided for UCL tears)
• Platelet-rich plasma (PRP) injection in selected cases
• Physical therapy for forearm, shoulder and core strength and mechanics
• A structured return-to-throwing program
• UCL repair or reconstruction for complete or persistent tears