Ulnar Collateral Ligament Injury

What is an Ulnar Collateral Ligament Injury?

The ulnar collateral ligament (UCL), also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow especially with overhead activities such as throwing and pitching. When this ligament is injured or torn, it can end a professional athlete’s career unless surgery is performed.

Symptoms of Ulnar Collateral Ligament Injury

The common symptoms associated with a UCL tear are as follows:

  • Pain on the inner side of the elbow
  • Unstable elbow joint
  • Numbness in the little finger or ring finger
  • Decreased performance in activities such as throwing baseballs or other objects

Causes of Ulnar Collateral Ligament Injury

Ulnar collateral ligament tear is usually caused by repetitive overhead throwing such as in baseball. The stress of repeated throwing on the elbow causes microscopic tissue tears and inflammation. With continued repetition, eventually the UCL can tear preventing the athlete from throwing with significant speed. If untreated, it can end an athlete’s professional career. UCL tear may also be caused by direct trauma such as with a fall, car accident, or work injury. Other causes include any activity that requires repetitive overhead motion of the arm such as tennis, pitching sports, fencing, and painting.

Diagnosis of Ulnar Collateral Ligament Injury

To evaluate UCL tear your doctor will perform the following:

  • Medical history
  • Physical examination including a valgus stress test to assess for elbow instability

Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis.

Treatment of Ulnar Collateral Ligament Injury

Your doctor will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in the sport, surgical reconstruction is performed.

Conservative treatment options that are commonly recommended for non-athletes include the following:

  • Activity restrictions
  • Orthotics
  • Ice compression
  • Medications
  • Physical therapy
  • Pulsed ultrasound to increase blood flow to the injured ligament and promote healing
  • Professional instruction

If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). It is also referred to as Tommy John Surgery. The most frequently used tissue is the palmaris longus tendon in the forearm.