What Is a UCL Tear?

The ulnar collateral ligament or UCL is a web of tough tissues located on the inside of the elbow – the pinky side when the palm faces up. The UCL links the humerus or upper arm bone to the ulna, which is the larger of the two lower arm bones. Its job is to stabilize and protect the joint when in motion. Tears to the UCL can result in pain and dysfunction and typically require some form of medical treatment. UCL injuries are commonly associated with athletes, such as baseball pitchers, volleyball players, and javelin throwers, whose activities require extensive overhead arm movement.

The diagnosis and treatment of a UCL tear usually requires an orthopedic surgeon or sports-medicine specialist. If you are experiencing pain or discomfort on the inside of your elbow, contact your Baptist Health primary care physician or an orthopedic specialist on our sports-medicine team.

What Are the Symptoms of a UCL Tear?

The following indicators may point to a UCL tear or injury:

• Stabbing pain or popping sounds in the region of the elbow
• Chronic elbow pain following heavy arm use
• Pain brought on by overhead arm movement
• Numbness or tingling in the fingers
• Weakening grip
• Reduced arm or elbow function

UCL tears mostly affect the overhead throwing motion. It is possible to have a UCL injury while still being able to perform most activities of daily living, such as showering, lifting groceries, or loading and unloading a laundry basket.

What Causes a UCL Tear?

UCL tears are caused primarily by overhead arm movement, either through accumulating wear and tear, or all at once by a particularly explosive motion. Sports in which UCL injuries are common include:

• Baseball (especially pitchers)
• Field events such as javelin throwing
• Gymnastics
• Tennis and other racquet sports
• Volleyball

UCL injuries can range in severity and are categorized accordingly. A first-degree sprain indicates a painful but intact ligament. The ligament of a second-degree sprain is stretched and painful, but still functioning. The UCL of a third-degree sprain is ruptured, painful, and no longer functional.

How Is a UCL Tear Diagnosed?

UCL tears are typically diagnosed by an orthopedist or sports-medicine specialist. He or she will take the following steps to determine the source of your elbow pain:

• Medical history and physical exam: Your physician will document your medical history and ask questions about your symptoms. He or she will be interested to know when they started, their frequency and severity, and how they’ve persisted or changed over time.
• Valgus stress test: Often a valgus stress test is critical in diagnosing ulnar collateral ligament damage. Your physician will apply stress to the elbow joint by bending your arm away from the midline. He or she will look for evidence of pain or a feeling of looseness in the joint that may indicate a loss of ligament integrity.
• Magnetic resonance imaging (MRI), X-ray, CT, or ultrasound scans: Imaging scans of the elbow can sometimes reveal excessive joint motion. The accuracy of an MRI is enhanced by injecting a dye called gadolinium into the joint prior to the scan.

Treatment recommendations will be based on the severity of injury – whether a first-, second-, or third-degree sprain.

How Is a UCL Tear Treated?

Treatment of UCL tears has two major components:

Non-surgical Treatment

There are several non-surgical methods of dealing with a less serious UCL injury:

• Rest
• Application of ice to reduce swelling
• The use pain-relief medications, including aspirin, naproxen sodium, or ibuprofen products
• Physical therapy

Surgical Treatment

More serious cases may require a surgical procedure known as UCL reconstruction or Tommy John surgery. The Tommy John procedure substitutes a tendon taken from elsewhere in the patient’s body, or, in some cases, from a donor, for the damaged portion of the ulnar collateral ligament.

What Is Recovery Like from a UCL Tear?

Recuperation time from a UCL injury varies according to severity and the type of treatment one receives. Tears requiring non-surgical treatment can take a few weeks to a few months to heal. Surgically repaired UCLs can take much longer to fully recover. (Tommy John, for whom the surgery is named after, sat out of baseball for a year before returning to the field.) The recovery program for UCL reconstruction requires wearing a hinged elbow brace and an extensive physical-rehabilitation regimen to strengthen the joint muscles and extend range of motion.

Can a UCL Tear be Prevented?

If you’re an athlete, avoiding a UCL tear can be difficult, depending on the nature of the sport you play. There are, however, certain steps you can take to put the odds more in your favor:

• Get a baseline physical exam before every season.
• Cross-train to avoid overburdening your body with a particular set of repetitive motions.
• Don’t skip warmups before competing.
• Wear applicable protective gear.
• Stay hydrated.
• Eat a healthy diet.
• Get rest.
• Don’t play through pain; injuries call for medical diagnosis and treatment.

It’s worth noting that professional sports organizations have begun implementing preventive measures to safeguard athletes against UCL injuries. This is one reason why Major League Baseball has instituted pitch counts as a means of reducing pitchers’ exposure to overhead throwing stress.

Learn More About UCL Tears and Treatment at Baptist Health

Don’t let an injured UCL leave you sitting on the bench. Schedule an appointment with the Baptist Health Sports Medicine team for the latest in diagnostic, treatment, and recovery programs for elbow pain and dysfunction.