Elbow

Ulnar Collateral Ligament Tears

An ulnar collateral ligament (UCL) tear is an injury to one of the ligaments on the inner side of your elbow. This ligament connects the inside of your upper arm (humerus) to the inside of your forearm (ulna) and helps support and stabilize your arm.

The UCL is rarely stressed in daily activities. It is injured in throwing types of sports or after elbow dislocation or surgery. It may occur as a sudden tear or may gradually stretch out over time with repetitive injury.

When torn, the UCL does not typically heal or may heal in a lengthened position. Sprains are classified into three grades. In a first-degree sprain, the ligament is not lengthened but is painful. With a second-degree sprain, the ligament is stretched but still functions. With a third-degree sprain, the ligament is torn and does not function.

Once thought to be a career-ending injury for professional athletes, ulnar collateral ligament (UCL) tears are now being diagnosed and treated early enough to allow athletes to return to competition. Surgery to correct UCL tears is commonly known as “Tommy John” surgery, named after the famous baseball pitcher who underwent the first surgery for a UCL tear in 1974.

Symptoms

Tearing of the ligament usually occurs following some localized soreness of the elbow on the inside. The actual tear is often felt as a ‘pop’ and you are usually unable to continue activity after it occurs. Other symptoms include:

  • Swelling and bruising (after 24 hours) at the site of injury at the inner elbow and upper forearm, if there is an acute tear
  • Inability to throw at full speed or loss of ball control
  • Elbow stiffness or inability to straighten the elbow
  • Numbness or tingling in the ring and little fingers and hand
  • Clumsiness and weakness of hand grip

Treatment

While there is a range of severity, when a ‘pop’ is felt, surgical repair is usually necessary to allow a return to competitive sports. The surgery is performed on an outpatient basis using a tendon from the arm or leg to repair the UCL. Your surgeon may first perform an arthroscopy to check for and repair any associated problems.

Following surgery, bracing is required for several weeks and a slow, progressive rehabilitation is important to allow for a successful outcome. Overhead motions and throwing are typically possible after three months and competition is typically allowed approximately 6-9 months after surgery.