What to Know About UCL Injuries of the Elbow

Medically Reviewed by Jabeen Begum, MD on November 07, 2022
5 min read

Soft tissue injuries can cause problems, especially for serious athletes. Damage to a ligament can mean pain, swelling, and a long recovery. Severe injuries to ligaments like the ulnar collateral ligament in the elbow may require surgery to repair. 

Learn more about ulnar collateral ligament injuries and how to treat them.  

An ulnar collateral ligament injury is any strain or tear of the connective tissue on the pinky finger side of your elbow. These injuries can affect the way you're able to move your arm. Treatment for severe ulnar collateral ligament injuries can require reconstructive surgery.

The elbow is one of the most complex structures in the body. It's where the two bones of the forearm — called the radius and the ulna — meet the humerus, which is the bone of the upper arm. There are three joints in the elbow, which allow a wide variety of movements in the arm. The joint include:

  • The humeroulnar joint, which enables the movements for bending and straightening the arm
  • The humeroradial joint, which assists with bending and straightening motions and allows the motion of turning the hand over, so the palm faces up or down
  • The proximal radioulnar joint, which allows you to rotate your lower arm

Ligaments are the tough bands of connective tissue that connect bones to one another. The ligaments in the elbow are:

  • The ulnar-collateral ligament, which runs along the inside of the elbow
  • The lateral collateral ligament, which runs along the outside of the elbow
  • The annular ligament circles the top of the radius and holds it against the humerus

The ulnar collateral ligament (UCL) is critical for overhead arm movements and throwing movements. The ligament supports and stabilizes the joint. An injury to the UCL can be painful and result in limits to your range of motion.

UCL injuries happen as a result of repetitive motion or acute trauma. A traumatic injury damages the ligament due to a single episode, like a fall or accident. The ligament might be torn in addition to other trauma, like a fracture or dislocation of the elbow.

Repetitive motion injuries to the UCL are most commonly seen in athletes who use an overhand throwing motion. Baseball pitchers are especially susceptible to UCL injuries. The frequent high-intensity movement of the elbow joint can cause the ligaments to stretch or tear over time.

UCL injuries vary in severity. Doctors classify them according to how much damage there is to the ligament:

  • Grade 1: The UCL is stretched but not torn.
  • Grade 2: The UCL is stretched and may be partially torn.
  • Grade 3: The UCL is completely torn.

Grade 1 or 2 UCL injuries are sometimes called a UCL sprain. UCL sprain symptoms include: 

  • Pain or tenderness on the inside of your elbow during or after overhead arm activity
  • Pain with any quick forward movement of the affected arm
  • Weak or unstable feeling at your elbow
  • Weak or clumsy hand grip
  • Loss of ability to throw with typical speed or force

Symptoms of a Grade 3 UCL tear include:

  • Feeling a sudden pop along the inner side of your elbow
  • Severe pain
  • Sudden inability to throw
  • Tingling and numbness in pinky and ring fingers.

If you suspect that you have a UCL injury, you should see a doctor. Typically, an orthopedic specialist would diagnose and treat this type of injury. At your appointment, the doctor will ask about the possible causes of the ligament strain and the symptoms you're experiencing. They may also order tests to determine the full extent of your injury. Tests could include:

  • Valgus stress test: This is a physical test where your doctor will put pressure on your UCL after raising your lower arm 30°. They will gently push your elbow toward your body while pulling your lower arm outward. If they detect looseness at the elbow joint and you feel pain, that indicates a UCL injury.
  • CT scan or X-rays: These imaging tests show pictures of your bones. Doctor can use them identify or rule out any possible stress fractures or other bone injuries.
  • Magnetic resonance imaging (MRI) scan or arthrogram: An MRI shows soft tissue injuries. It will allow your doctor to see the full extent of damage to your ligament. An arthrogram is an MRI performed after your doctor injects dye into the joint. The dye makes some injuries easier to see.

UCL sprain treatment varies depending on the severity of the injury. If you have a relatively minor injury to your UCL, your doctor may prescribe nonsurgical treatment. The injury may heal without the need for an operation. Nonsurgical treatment may include: 

  • Rest
  • Icing the injury
  • Over-the-counter medications to reduce pain and inflammation, like ibuprofen or naproxen
  • Prescription-strength medication for pain and inflammation if your doctor advises it
  • Physical therapy
  • Injections of platelet-rich plasma (PRP)

If your injury is severe or nonsurgical treatment isn't effective, your doctor may recommend surgery to repair the injury. In some cases, doctors can reattach the torn ligament. In more severe cases, you may need ligament reconstruction surgery. 

The procedure for UCL reconstruction is known as "Tommy John surgery." It's named after baseball pitcher Tommy John, who was the first patient to have the procedure in 1974. With Tommy John surgery, your doctor takes a tendon from another area of your body or uses a tendon from a donor. They attach the new tendon to your ulna and humerus. It will then act as your new UCL. Parts of your original UCL may also be attached to the new tendon to strengthen it. After surgery, you'll wear a brace and do physical therapy.

UCL sprain recovery time depends on the severity of the injury and what treatment you need. Recovery with nonsurgical treatment can take up to several months. Recovery after Tommy John surgery takes nine months to a year.

UCL injuries are uncommon for people who don't have occupational or athletic risks. Normal elbow movements typically don't result in repetitive motion injuries to the UCL. If you engage in high-risk activities such as pitching in baseball, talk to an athletic trainer about appropriate conditioning and proper form and movement to prevent elbow strain. Rest your arm if you feel pain or fatigue in the joint. 

If you are concerned about a UCL injury, call your doctor. They can help you diagnose and treat any problems with your UCL.