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What is a UCL Injury?

The ulnar collateral ligament (UCL), also called the medial collateral ligament, is one of four elbow ligaments. It connects the upper arm bone (humerus) and the ulna bone in the forearm. 

Most people don’t use their UCL much during an average day, but it is a crucial ligament for some athletes. The UCL performs the essential function of keeping the elbow joint stable while throwing a ball.

UCL tears are usually caused by repeated stress and overuse of the arm. It is also commonly known as a Tommy John injury

What are the grades of an UCL injury?

UCL tears are classified into three grades based on the severity of the injury in the elbow:

A mild injury where the UCL ligament is stretched but not torn.

A moderate injury where the ligament is stretched and partially torn.

A severe injury where the ligament is completely torn.

What are UCL tear symptoms?

UCL injuries typically happen gradually, but early warning signs that something is wrong can include a loose elbow joint and pain. Severe UCL tears can happen suddenly, mainly if you fall on your outstretched arm or are hit in your elbow. Torn UCL symptoms include:

  • Feeling a pop inside your elbow
  • Pain, from mild to severe, on the inner side of your elbow
  • Inability to grip with your hand or throw fast or with force 
  • Loose or weak feeling in your elbow
  • Tingling and numbness in your fingers

Risk factors and causes of a UCL injury

You can damage your UCL through overuse which can stretch, inflame, and tear the ligament fibers. A UCL sprain or tear typically occurs gradually from wear and tear as the ligament loosens and weakens. Baseball pitchers are at the highest risk of a UCL injury, but other athletes who repeatedly complete overhead or throwing motions can also injure their UCL.

How is a UCL injury diagnosed?

A physician will usually conduct a physical examination and use imaging technology to diagnose an injured UCL. A Tommy John injury is notoriously tricky to identify and benefits from having a sports medicine doctor examine the injury.

Tests for diagnosing a torn ligament in the elbow include:

  • A physical exam to measure your range of motion, elbow strength, and stability
  • X-rays to identify any damage, such as a fracture or break in the bone in your elbow or arm
  • Magnetic resonance imaging to determine the severity and location of the tear 

What is the treatment for a UCL tear?

Torn UCL treatment varies based on the severity of the injury. Rest and physical therapy are often enough to heal from minor injuries. Surgery may be necessary for more severe injuries, particularly for pitchers and other athletes.

Treatment options for healing ulnar collateral ligament injuries without surgery focus on increasing elbow stability and strength. These include: 

  • Resting and refraining from throwing
  • Applying ice or heat to the elbow 
  • Taking pain and anti-inflammatory medication 
  • Platelet-rich plasma injections 
  • Physical therapy to improve strength and flexibility

Tommy John surgery is named for the baseball pitcher who had the first ulnar collateral ligament reconstruction surgery in 1974. The procedure replaces the damaged ulnar collateral ligament with healthy tendon tissue from another part of your body. The surgery is designed to recover strength, motion, and stability in your throwing arm. 

Tommy John surgery is usually reserved for athletes that make repeated throwing motions, such as softball and baseball players. You might need Tommy John surgery if you’ve noticed a decrease in velocity while throwing, you are fatiguing quickly, or you have tingling or numbness in your hands or fingers. Pain in your throwing arm is another standard indicator you might need surgery.

Mass General Brigham Sports Medicine physicians work on the most cutting-edge sports medicine research, technology, and treatment. Our Hand and Arm treatment team uses innovative approaches to treat the full spectrum of hand and elbow disorders. 

Preventing UCL injuries

If you’re an athlete who plays softball, tennis, javelin, or another sport requiring repeated throwing motions, you’re at a higher risk of a UCL injury. Whether you’re recovering from an injury or simply want to avoid over-stretching or tearing this vital ligament, follow these steps:

  • Stretch and warm-up before physical activity
  • Slowly increase your pitching force and speed
  • Avoid pitching or throwing when your arm is sore 
  • Consult an athletic trainer to ensure you’re using the proper technique
  • Regularly ice your arm after playing to prevent inflammation

Recovering from a UCL tear

UCL tears used to be considered career-ending injuries for pitchers and other athletes. Today, physicians and athletic trainers can diagnose and treat these injuries well enough that athletes can recover fully.

The length of your recovery time will depend on the severity of your injury and whether you had surgery on the ligament. A standard recovery time following Tommy John surgery is at least four months to return to throwing activity. It routinely takes professional athletes at least nine months and often more than a year before they can return to sports.

If you have a UCL injury and want to return to sports, you will need to undergo physical therapy to regain strength and stability in your arm. Schedule a telehealth visit with one of our sports medicine experts to understand your recovery options. Same-day appointments are often available. 


If your injury is mild enough that you don’t need surgery, you can make a full recovery within a few weeks. For some, it could take as long as two months. If you require surgery to fix your damaged ligament, it routinely takes at least nine months to heal and regain the strength and stability in your arm.

The ulnar collateral ligament can heal without surgery in the case of a mild sprain or partial tear. Rest, treatment, and physical therapy can help minor injuries recover. However, more severe injuries require surgical reconstruction to heal completely.

You can treat a UCL injury from home if your injury is mild. This treatment typically requires resting the affected arm, taking anti-inflammatories, and completing strength, stability, and range of motion exercises. You should consult an athletic trainer or sports medicine doctor if you’re an athlete interested in treating a UCL injury from home.

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