The ulnar collateral ligament (UCL) runs along the inside of the elbow, connecting the inner sides of the upper arm (humerus) and forearm (ulna). This ligament is key to providing support and stability to the arm, but it’s hardly ever stressed in day-to-day activities. Tears to the UCL generally only occur from a repetitive throwing motion, so this injury most commonly affects overhead throwing athletes. As a sports specific clinic, we regularly treat UCL injuries in college and professional baseball pitchers, as well as the occasional tennis and volleyball player.

Before the mid-1970s, a UCL tear was a terrible diagnosis for an athlete, because it was considered a career-ending injury. However, in 1974, Major League Baseball pitcher Tommy John underwent the first surgery to correct a UCL tear and went on to play for another 15 years. Today, UCL surgery is often referred to as Tommy John Surgery in his honor.

Injury to the UCL can occur gradually as the ligament stretches overtime or may be a sudden tear. Athletes who are developing a UCL injury might notice pain on the inside of the elbow, a decrease in stability or functionality of the elbow, or tingling associated with the “funny bone” (ulnar nerve).

There are three grades of a UCL sprain. In the first, the ligament is not lengthened or torn, but the patient still experiences pain. Second degree sprains show a stretched ligament


that’s still functional. In a grade three sprain, the ligament has torn and cannot function.

An athlete that gets diagnosed with a third-degree UCL injury will need to undergo Tommy John Surgery in order to return to their regular level of activity. In this procedure, the UCL gets replaced with a different tendon from the arm or leg. After Tommy John Surgery, it’s important for an athlete to follow a careful rehabilitation program in order to return to the prior level of activity. Immediately following surgery, the elbow needs to be braced at 90 degrees, but motion should be maintained in the wrist and shoulder. Gradually, we will work to increase movement in the elbow until the patient is ready to incorporate gentle exercise and, finally, work on the strength of their throwing motion. The total recovery time can be 6-12 months.

At MOTUS, we have treated dozens of UCL injuries and have successfully helped each client return to their sport after their surgery. It can feel like a long process, but if you are patient, careful, and hardworking, we can help you get back to your sport with confidence.

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