UCL Injury Overview “Tommy John Surgery”

The ulnar collateral ligament (UCL) of the elbow is a structure that is critical for elbow stability. The UCL is a triangular, thick section of tissue that maintains a healthy and normal relationship between the upper arm bone (humerus) and the ulna (forearm bone on the pinky side). An ulnar collateral ligament injury can range from a mild stretch to a full tear. An ulnar collateral ligament tear is usually the result of a sports injury that involves repetitive overuse and forceful motion, such as that seen in pitchers and throwers.. Microtrauma develops as a result of repetitive force placed on the ligament during the throwing motion. While a UCL injury can occur in isolation, it can also occur with elbow dislocation.

Diagnosis of UCL Injury

Dr. Millett will conduct a thorough physical examination and MRI of the elbow to assess whether there is a UCL injury present. This will allow him to view the soft tissue structures of the elbow, and based on his exam, he will be able to determine the grade (severity) of injury to the ulnar collateral ligament tear.

There are three classifications for a UCL injury of the elbow:

  • A first-degree sprain occurs when the ligament is strained without it becoming stretched. This strain leads to elbow pain.
  • A second-degree sprain occurs when the ligament is stretched. While the patient will experience increased pain, especially with movement, the elbow can still function.
  • A third-degree sprain occurs when the ligament has been torn or ruptured. An ulnar collateral ligament tear results in an elbow that loses function all together.

UCL Injury Symptoms

Patients who sustain an ulnar collateral ligament (UCL) tear will experience elbow pain, numbness, and swelling. Elbow instability will also occur. Some patients suffering from an elbow ligament injury may have trouble gripping items with their hands. Athletes will experience a loss of control with throwing and will not be able to complete a throw at full speed or strength. When an UCL injury occurs, a pop or pulling sound can be heard. These symptoms may or may not be present, depending upon the severity of the injury.

Have you sustained a UCL injury?

There are two ways to initiate a consultation with Dr. Millett:

You can provide current X-rays and/or MRIs for a clinical case review ($250).

You can schedule an office consultation with Dr. Millett.

Treatment for Ulnar Collateral Ligament Tears


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. Dr. Millett may place the arm in a cast or splint in order to allow the ligament to heal properly and stay protected. Additionally, physical therapy may be utilized to strengthen surrounding muscles and improve throwing mechanics.


In high-level athletes, patients who have acute trauma associated with an ulnar collateral ligament tear, we are now performing UCL repair and this is augmented with an internal brace to provide additional stability. Recovery is typically 4 to 5 months.

In those with chronic UCL tears or for those who experience persistent elbow pain and elbow instability, a reconstruction surgery may be required.  Ulnar collateral ligament tears and ruptures that are more chronic are treated using a 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 to reconstruct the ligament. Research has shown that this particular tendon provides similar anatomical characteristics as the native ligament.  Some patients may require an allograft (donor tissue) to achieve reconstruction.

Following ulnar collateral ligament surgery, patients are required to wear a brace 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 4-6 months following surgery. Throwing at a competitive level may take a full year for maximal recovery.

For additional resources on ulnar collateral ligament tears, or to determine the appropriate treatment for your UCL injury, please contact the orthopedic practice of Dr. Peter Millett.

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