Ulnar Collateral Ligament (UCL) Injuries

Ulnar Collateral Ligament (UCL) Injuries

Our muscles, bones and joints work together to move our bodies and keep us stable. But they can’t accomplish this without a bit of help from our ligaments. Originating from the Latin word “ligare,” meaning to bind or tie, ligaments are strong cords of connective tissue that hold bones together and help stabilize joints. Ligaments help ensure that bones don’t twist too much or move too far apart and become dislocated.

While ligaments are strong, they are not immune to injury. If ligaments become torn or otherwise stressed, the surrounding bones also become vulnerable to injury.

The ulnar collateral ligament (UCL) is found in the arm. Injuries to the UCL are common in athletes whose sports involve throwing, such as football, baseball, softball and javelin. Understanding this injury, including its causes, symptoms, diagnosis, treatment and recovery, can help you decide if you need to see a hand surgeon for evaluation.

While we will focus on injuries to the elbow, UCL injuries can also occur to tissue that provides support to the thumb joint. You can treat ulnar collateral ligament injuries to the thumb with surgery.


Table Of Contents

What Is the Ulnar Collateral Ligament?

The ulnar collateral ligament is located in the elbow on the side closest to the body. One end connects to the bone in the upper arm (humerus), and the other end connects to a bone in the lower arm (ulna). Three parts make up the UCL: the front (anterior), the back (posterior) and the side (transverse) bands. The front band is the most important for elbow stability.

What Causes a UCL Injury?

UCL injuries range from minor damage to complete tears. Injuries to the UCL can occur in a few different ways:

Tears From Overuse

Most UCL injuries happen due to excessive elbow use. UCL injuries are commonly thought of as baseball injuries because repeated motions, like throwing overhand, can stress the ligament. Over time, continued strenuous use can cause the UCL to stretch, straining and weakening the connective tissue. The ligament can develop small tears that further compromise its structure. The UCL can partially or completely tear, or one end may separate from the bone.

Traumatic Blows to the Elbow

Traumatic Blows to the Elbow

A severe blow to the elbow can also damage the UCL. Trauma like this usually happens during an abrupt injury and often results in an ulnar collateral ligament tear or rupture. Falling and landing on an outstretched arm, for example, can jar your elbow and cause it to dislocate or fracture. Injuries common in gymnastics and wrestling can also traumatically injure the UCL.

What Are the Symptoms of a UCL Injury?

UCL injury symptoms can vary depending on how severe the injury is.

Symptoms of a mild to moderate UCL injury include the following:

  • Pain on the inside of your elbow during or following a session of arm activity
  • Discomfort when you quickly move your arm forward, such as when throwing
  • Feeling like your elbow joint is weak, loose or unstable
  • A clumsy, ineffective grip
  • Not being able to throw as hard or fast as usual

Symptoms of an ulnar collateral ligament tear include the following:

  • Sensing or even hearing a sudden burst along your inner elbow
  • Intense pain
  • Inability to throw
  • Numbness or tingling in your ring and pinky fingers, which may mean your ulnar nerve has been pinched or damaged in the injury

How Is a UCL Injury Diagnosed?

When you seek treatment for a UCL injury, your doctor will review your medical history and conduct a physical exam. They’ll assess your elbow’s appearance, strength, stability and range of motion. They’ll also ask about the location and characteristics of your pain.

Your health care provider may also use diagnostic tests to confirm your injury. These may include:

  • A valgus stress test: In this physical test, your doctor will raise your arm to 30 degrees and place their fingers over your UCL. Then, they will nudge your elbow toward your body while pulling your lower arm away from your body. Your valgus stress test is positive if you feel looseness and pain in your elbow.
  • Computed tomography (CT) and X-rays: These scans create images of your bones. They can show fractures or other bone issues that may be causing your elbow pain.
  • Magnetic resonance imaging (MRI): This scan creates images of soft tissues like tendons and ligaments.
  • Arthrogram: This test is an MRI that also uses dye injected into your elbow to help your doctor see small injuries.

How Is a UCL Injury Treated?

UCL injury treatment is based on how severe your injury is and how much you plan to use your arm for throwing and other overhead movements. A mild UCL tear may heal independently, while surgical and nonsurgical treatment methods are available for more serious injuries.

Nonsurgical UCL Injury Treatments

Your health care provider may recommend minimally invasive treatments like the following:

  • Icing the injury
  • Resting the affected arm
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen
  • Going to physical therapy
  • Receiving platelet-rich plasma (PRP) injections, which use your own platelets to treat partial UCL tears

Surgical UCL Treatments

If your injury is severe or if nonsurgical treatments don’t work for you, your doctor may suggest surgery. The goal of UCL surgery is to stabilize and strengthen the elbow, restore range of motion and ease pain. The following surgeries treat UCL injuries:

  • UCL direct repair: If an abrupt injury caused your UCL to pull away from the bone, it might be possible to reconnect it.
  • UCL reconstruction (Tommy John surgery): In this procedure, your surgeon will replace the damaged tendon with a new one that comes from another part of your body or a donor.

Recovering From a UCL Injury

If nonsurgical methods are enough to treat your injury, it may take several weeks to months to recover.

If your injury requires surgery, you may need nine months up to a year or longer to recover. You will wear a hinged brace on your elbow that will allow you to slowly increase your range of motion until you can fully extend your arm again. If you are an athlete and planning to return to your sport, you will likely need pain management and physical therapy to strengthen your elbow enough to withstand the wear and tear.

While everyone’s recovery is different, you should not rush to return to your sport. Instead, allow your body plenty of time to heal so you can return to your lifestyle with minimal risk of injury.

Trust Your Arm Injury to the Hand Center of Louisiana

Trust Your Arm Injury to the Hand Center of Louisiana

The highly-trained physicians and therapists at the Hand Center of Louisiana specialize in all conditions affecting the hands and upper extremities. From the initial medical evaluation to diagnostic tests, treatment and follow-up care, we offer a seamless, integrated patient experience. Request an appointment today and get yourself on the road to recovery.