Walt Smith, M.D., is a shoulder and elbow surgeon with UAB Sports & Exercise Medicine. Here, he answers some common questions about ulnar collateral ligament (UCL) injuries and how they’re treated. This information is based on a typical patient and may not apply to every case.
What is a UCL injury?
The UCL is the ligament on the inner (medial) side of the elbow. It is sometimes called the “Tommy John ligament”. It is a thick band of tissue that stabilizes the elbow during overhead or throwing activities. UCL injuries can range from partial to complete tears.
How does this type of injury usually happen?
UCL injuries are most often caused by repetitive stress or overuse, so they’re frequently seen in baseball players and other athletes who perform a lot of overhead movements. They can also occur as part of a single traumatic event, but this is less common.
What are the immediate symptoms?
Athletes who throw usually notice a loss of power and control after a UCL injury. Pain may be felt above the inside of the elbow, especially during certain phases of throwing when the arm is overhead. Some people feel a “pop” in the elbow when the injury happens.
How is a UCL injury diagnosed?
Gathering a thorough medical history and performing a physical exam are important first steps in diagnosing a UCL injury. If a tear is suspected, the next step in most cases is an MRI scan. This usually includes an arthrogram, where a contrast dye is injected into the elbow before the MRI. This provides a better internal view of the injured area.
Does it require surgery?
It depends on the patient and how bad the tear is. Partial tears are often treated with rest and specific rehabilitation exercises, especially in non-throwing athletes. Full tears in elite athletes – specifically in throwers – are frequently treated with surgery, to allow them to return to competition.
What does recovery typically look like?
Non-surgical treatment usually involves a period of rest, physical therapy, and a gradual return to throwing. A platelet-rich plasma (PRP) injection also may be considered. Recovery after surgery involves active rehabilitation with early range of motion for the shoulder, elbow, and wrist. Strengthening exercises typically begin 4-6 weeks after surgery. A progressive throwing program is eventually started, and athletes must successfully complete each phase before advancing to the next.
When can someone with a UCL injury return to play or activity?
Return to competitive throwing after surgery often takes 6-12 months. This depends on multiple factors, including whether a full reconstruction was required versus a repair. Completing each phase of a progressive throwing program is critical in determining when an athlete is ready to return to play.
Can this injury be prevented?
Preventing UCL injuries involves a combination of proper mechanics, workload management such as pitch counts, specific strength training and conditioning, and allowing enough time for recovery after training.
When should someone with a UCL injury see a sports medicine specialist?
You should seek proper medical attention if you suspect a UCL injury, especially if you have severe elbow pain, loss of function, or any other symptoms that do not go away with rest.
To make an appointment with UAB Sports & Exercise Medicine, please call 205-930-8339 or schedule a visit online at uabmedicine.org/sports.