Elbow Ulnar Collateral Ligament (UCL) Injury

Your ulnar collateral ligament (UCL) is a band of fibrous connective tissue on the inside of your elbow. Repetitive use or trauma can cause the ligament to become injured, torn, or detached. University of Iowa Health Care orthopedic and sports medicine specialists have the expertise and experience to diagnose and treat UCL injuries.

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Your ulnar collateral ligament (UCL) is a band of fibrous connective tissue on the inside of your elbow. It helps to keep your elbow joint stable during movement. If you put stress on the ligament from repetitive throwing, overuse, or a traumatic fall, the ligament can become injured, torn, or detached.

With extensive experience and specialized expertise, University of Iowa Health Care orthopedic and sports medicine specialists use advanced diagnostic tools and the latest treatments to accurately diagnose and effectively treat UCL injuries.

Our dedicated orthopedics hospital is designed to deliver comprehensive care in one convenient location. With clinic visits, surgical procedures, and physical therapy all housed under one roof, you can expect seamless, coordinated care throughout your treatment.

Types of UCL injury

UCL injuries are generally classified by their severity and location. In terms of severity, they range from mild sprains to complete tears. For location, tears can occur at the proximal (upper) end near the humerus, which is the long bone in the upper arm); in the mid-substance (central portion of the ligament); or at the distal (lower) end near the ulna, which is the longer of the two bones in the forearm. Identifying the exact location helps guide treatment decisions, which may include rest, rehabilitation, or surgical intervention.

What can cause an UCL injury?

UCL injuries can result from both repetitive stress and traumatic injuries.

Continued strenuous use over months or years can cause your UCL to become irritated and break down. In sports like baseball and javelin, the injury is often caused by repetitive throwing motion, which places high stress on the elbow and can lead to either gradual damage or sudden overload of the ligament.

Any traumatic injury to the elbow, such as a fall, can result in an injury to your UCL. With contact sports such as football and wrestling, UCL injuries usually occur from falling on an outstretched arm or the elbow being forced into an unnatural position, resulting in anything from minor sprains to complete ligament tears.

Who is likely to experience a UCL injury?

UCL injuries overwhelmingly affect athletes—about 95% of cases—particularly those involved in repetitive throwing sports like baseball or softball or contact sports such as wrestling or football.

While UCL injuries are most common among athletes, they are not exclusive to sports. Non-athlete individuals can also experience UCL injuries, typically due to traumatic falls or repetitive manual labor. While these injuries are less frequent outside of sports, they can still significantly impact your elbow's stability and function.

UCL injuries in baseball

Baseball pitchers are one of the most affected groups because the repetitive, high-velocity throwing motion places extreme stress on the UCL. They are more likely to develop a UCL injury if they have high pitch counts, pitch while fatigued, and play year-round without proper rest.

To combat this, organizations like Little League and USSSA have implemented pitch count limits and mandatory rest periods, which are backed by strong evidence showing they help reduce injury risk. Guidelines also recommend that young throwers take at least two to three months off from throwing each year to allow for recovery and growth.

Symptoms of an UCL injury

The most common symptom of a UCL injury is pain on the inner side of your elbow, especially during or after throwing. Athletes often describe a sharp or aching pain that worsens with overhead motions like pitching or serving. In some cases, there may be swelling, particularly if your injury is traumatic. More severe injuries can cause a sensation of looseness or instability in your elbow, and some individuals may feel or hear a "pop" at the time of injury.

How is an UCL injury diagnosed?

Diagnosis begins with a thorough physical examination, where your provider will examine the inside of your elbow and perform specific stress tests to assess the integrity of the ligament. If the exam suggests a UCL injury, advanced imaging may be ordered. This may include:

Magnetic resonance imaging (MRI). Allows your provider to view soft tissue injuries like ligament tears.
Ultrasound. Guided ultrasounds can assess soft tissue injury. They also have the ability to assess the injured area while in motion. Your provider is able to see what is happening to the ligament during movement, allowing for a more accurate diagnosis.
X-ray or computed tomography (CT) scans. If your provider thinks your injury may also include fractured bones, they may recommend additional scans.

UCL injury treatment options

Treatment for a UCL injury depends on several factors, such as the severity of your injury, the location of your injury, and the quality of your tissue.

It’s important to know that surgery isn’t always necessary, and many patients, especially non-athletes, can return to a normal, active lifestyle without surgery. For partial tears or injuries with good tissue quality, conservative treatment is often the first step:

Rest

Avoid throwing or stress on the elbow.

Physical therapy

Focus on strengthening the shoulder, core, and legs to reduce stress on the elbow.

Anti-inflammatory medications

Manage pain and swelling.

Platelet-rich plasma (PRP) injections

A biologic treatment that may help accelerate healing in partial tears.

Recovery with conservative care typically takes several months, and success depends on the extent of your injury and how well you follow your recovery plan.

UCL repair

UCL repair is suitable for injuries where the ligament has been pulled away from the bone but remains healthy.

During repair, your UCL is surgically reconnected and reinforced with an internal brace—a strong suture tape that adds stability during healing. UCL repair is a good option for younger athletes because it is less invasive and has a shorter recovery time (typically six to nine months).

However, depending on your injury and the quality of your tissue, repair may not be the best option. Your surgeon may plan for a repair but switch to reconstruction during surgery if your tissue isn't strong enough or if your ligament has snapped in the middle.

Tommy John surgery (UCL reconstruction)

Tommy John surgery, also known as UCL reconstruction, is typically used when the UCL injury is torn in the middle of the tissue or if it is not healthy or strong enough for repair. This procedure involves replacing your damaged ligament with a tendon graft, usually taken from your forearm or hamstring.

Tommy John surgery is a long-established surgical option for UCL injuries and has a proven track record of success. However, recovery from reconstruction is much longer than with UCL repair (typically at least nine to 12 months).

UCL repair vs. UCL reconstruction

The choice between UCL repair and UCL reconstruction depends on the location of your tear and the quality of your ligament tissue. UCL repair is typically used for newer injuries where the ligament has been pulled from the bone but remains healthy. UCL reconstruction is used when the ligament is torn in the middle or too damaged to repair. Surgeons often plan for a repair but are prepared to switch to reconstruction during surgery, if needed.

A team-based approach to care

Our orthopedic and sports medicine specialists offer a collaborative, patient-centered approach to UCL injuries. Our team is made up of experienced physicians, nurses, athletic trainers, and imaging specialists who are highly familiar with this injury and its treatment options.
We’re here to help you understand your options and feel confident in your recovery path. Whether the best course is nonsurgical treatment like rest and physical therapy, or a more advanced option like repair or reconstruction, we tailor your care to your specific needs and goals.