Ulnar Collateral Ligament (UCL) Tear

Ligaments are strong bands of tissue that hold bones together. In the elbow joint, the ulnar collateral ligament, or UCL, holds the ulna (lower arm bone) to the humerus (upper arm bone). When the ulnar collateral ligament gets torn due to injury, the elbow can become unstable.

The most common symptom of a torn ulnar collateral ligament elbow injury is pain on the medial side (inside, or pinky finger side) of the arm, from the elbow to the wrist. Occasionally, a baseball player who tears his UCL may feel a “pop” with intense pain after throwing.

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

Non-Surgical

A mild ulnar collateral ligament injury will often resolve on its own with conservative treatment. This includes rest, ice, non-steroidal anti-inflammatory medications, and sometimes, therapy. Your Peninsula Bone & Joint Clinic physician will most likely place the arm in a cast or splint for a period of time in order to allow the ligament to heal properly and stay protected.

Surgical

In high-level athletes, patients who have acute trauma associated with an ulnar colateral ligament tear, or for those who experience persistent elbow pain and elbow instability, a reconstruction surgery may be required. Ulnar colateral ligament tears and ruptures are treated using an arthroscopic surgical approach where the ligament is reconstructed using a soft tissue graft. This surgical technique, known as the “Tommy John” procedure, will use the patient’s own tissue from the forearm because evidence-based research has shown that this particular tendon provides similar anatomical characteristics as the native footprint. Some patients may require an allograft (donor tissue). In acute circumstances where a larger portion of the ligament is damaged, a tendon transfer may be necessary.

Following ulnar collateral ligament surgery, patients are required to wear a cast for approximately 6 weeks after which moderate exercises and movements of the arm can occur. Physical therapy will be a progressive process that will initially focus on range of motion, and later, strengthening exercises. Most patients are able to return to their sporting activities in roughly 3-4 months following surgery.