UCL (Tommy John) Injury

A UCL injury (Tommy John injury) is an inner elbow injury. It happens when you stretch or tear your ulnar collateral ligament. Your UCL is a strong band of tissue on the pinky finger side of your elbow.

This ligament supports your elbow joint. You use it when you raise your arm to throw something overhead. Overuse is the most common reason why people injure their UCLs.

Ulnar collateral ligament injuries are most common in people who play sports that involve repeatedly throwing a ball or another object overhead. Baseball is a prime example. The injury’s nickname refers to a famous baseball player who recovered from a severe UCL tear after surgery. But anyone who repeatedly uses strenuous overhead arm movements can have a UCL injury.

Grades of UCL injuries

Healthcare providers characterize ULC injuries by the amount of damage done to your ligament. The classifications or grades of UCL injuries are:

• Grade 1: Your ligament is stretched but not torn.
• Grade 2: Your ligament is stretched and may have a small tear.
• Grade 3: Your ligament is completely torn.

Very rarely, a UCL injury will pull a small piece of bone when the ligament tears away from the bone (avulsion fracture).

Symptoms of a UCL injury

Your symptoms depend on whether you stretch or tear your UCL. They may be mild or moderate (Grades 1 and 2) or severe (Grade 3).

You may have a mild to moderate injury if you:

• Can’t throw a ball or object as fast or as hard as you usually do
• Have pain and tenderness on the inner side of your elbow, particularly pain you notice during or after activities like throwing balls overhead
• Have pain when you quickly move your arm forward to reach for something
• Feel like your elbow is unstable or weak
• Notice your hand grip seems weak

You may have a severe injury if you:

• Feel a sudden pop along the inside of your elbow
• Have severe pain
• Lose your ability to throw
• Feel tingling and numbness in your pinky and ring fingers

Tommy John injury causes

Repetitive stress, falling on your outstretched arm and traumatic injury may lead to a Tommy John injury:

• Repetitive stress or overuse can happen when you repeatedly raise your arm to throw something.
• Traumatic injury from falling on your outstretched arm can cause a UCL tear.
• Dislocating your elbow or breaking it can damage your UCL.

How doctors diagnose ulnar collateral ligament injuries

Your healthcare provider (usually an orthopedic specialist or a sports medicine specialist) will review your medical and athletic history. They’ll do a physical examination. They’ll check to see if it hurts when you move your arm or elbow. During the exam, they’ll check:

• How far you can move your arm (range of motion)
• Your elbow strength and stability
• Your arm muscle mass and appearance

They may do a valgus stress test to see if your elbow joint is loose.

They may do other imaging tests like:

• CT scan and X-rays to check for bone stress fractures and other bone issues that may cause elbow pain or keep you from moving your elbow
• MRI scan that may show injuries to tendons and ligaments or small fractures
• Arthrogram, which gives providers a detailed view of what’s going on inside your elbow joint

How is a torn UCL treated?

That depends on your situation. A small tear in your UCL may heal on its own or with nonsurgical treatments. But you may need surgery if you have a severe injury.

Your healthcare provider may recommend PRICEMM to support healing. PRICEMM stands for:

• Protection: This could be a hinged-elbow brace that supports your elbow while your ligament heals.
• Rest: This means taking a break from activities where you use overhead throws.
• Ice: Applying ice to your elbow eases pain and swelling.
• Medication: This may be NSAIDs like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®). Ask your provider about a prescription-strength NSAID if you need it.
• Modalities: This is physical therapy to strengthen the muscles around your elbow.

Your orthopedic specialist may recommend platelet-rich plasma injections. This treatment involves injecting platelets from your blood into your ligament. The platelets help your UCL heal.

Surgical treatments are:

• UCL direct repair, which reattaches your UCL to your bone
• Tommy John surgery, which fixes torn or unstable UCLs by reinforcing them with a piece of healthy tendon

When should I seek care?

Talk to a healthcare provider if you have elbow pain or weakness that affects your ability to make overhead throws. They may refer you to a specialist for tests and treatment. If you’re receiving treatment, let your provider know if your symptoms get worse.

What can I expect if I have an ulnar collateral ligament injury?

You should expect to be patient and take it easy while your ligament heals. The time it may take to heal depends on your situation. If you need surgery, recovery may take a year. Recovery time may be shorter if you tear your UCL but don’t need surgery. It may be several weeks or months for your ligament to heal.

Can UCL injuries be prevented?

Proper conditioning, proper elbow movement technique and rest when you feel elbow discomfort can help prevent ulnar collateral ligament injury. In athletes, a pitch count limit and required rest can help protect against injury.