The ulnar collateral ligament (UCL) is located on the inside of the elbow. Ligaments are tissues that hold the bones together. The upper arm bone (humerus) is attached to a bone in the forearm (ulna) by the UCL (Picture 1). This ligament can be injured by being stretched or torn. This injury can change the stability of the elbow. 

There are different types of UCL injuries. These are called grades. UCL grades are:

  • Grade I (1) – involves no tear, but the ligament is stretched
  • Grade II (2) – the ligament is stretched and, often, partially torn
  • Grade III (3) – there is a complete tear through the ligament

Causes

  • Overuse – The UCL can be torn by stress from using it too much (overuse). This injury is common in baseball pitchers and other athletes that throw. This pain is not normal.
  • Trauma – A fall onto an extended arm may cause the UCL to tear or pull away from the bone. This can happen in contact sports.

Signs and Symptoms

  • stiffness
  • a pop or pain at the inner elbow
  • numb feeling or tingling in the 4th and 5th finger
  • pain during and after throwing or other activities

Diagnosis

Most of the time, a UCL injury is diagnosed by an orthopedic provider. Orthopedic providers focus on bones, muscles, ligaments, and more. These help your body move.

stiffness a pop or pain at the inner elbow

numb feeling or tingling in the 4th and 5th finger pain during and after throwing or other activities

stiffness a pop or pain at the inner elbow

numb feeling or tingling in the 4th and 5th finger pain during and after throwing or other activities

  • A physical exam will be done on the elbow to see if there is any concern for injury.
  • X-rays will be done to check for injury to the bone. A tear in soft tissue would not show up on an X-ray.
  • A magnetic resonance imaging (MRI) test may be done to see if there is an injury to the ligaments in the elbow. The orthopedic team will either set up an appointment for you to get the MRI results, or they will call you with the results within a few days.

Treatment

Treatment will depend on testing results.

  • If the ligament is only torn a little, your child may be treated with rest, bracing, and physical therapy.
  • If surgery is needed, it is usually scheduled within a few weeks of your child’s injury and after all testing is done. The health care provider will explain the surgery and choose the best surgical option for your child. There are 2 different options for surgical procedures used to treat a UCL tear: repair or reconstruction.

After Surgery

The following are things you and your child need to do after surgery:

  • Immobilization – Your child will be in a long arm splint until the first follow-up appointment.
  • Keep the splint in place. Do not remove it.
  • Keep the splint clean and dry.
  • Medicine
  • If needed, your child will get a prescription for pain medicine.
  • The health care provider may suggest that you add ibuprofen (Motrin®) and acetaminophen (Tylenol®) for pain relief. These will help reduce pain and swelling. Motrin can often be taken every 6 hours. Tylenol can be taken every 4 hours.
  • Ice
  • The provider may tell your child to use ice over where their injury is for the first few days to help with swelling and pain.
  • Physical therapy
  • Physical therapy will start after the first follow-up appointment. This is usually 1 week after surgery.
  • Exercises should be done at home, too. They will help your child’s injury get better and improve their elbow movement.

When to Call the Health Care Provider

  • Keep the splint in place. Do not remove it.

  • Keep the splint clean and dry.

  • If needed, your child will get a prescription for pain medicine.

  • The health care provider may suggest that you add ibuprofen (Motrin®) and acetaminophen (Tylenol®) for pain relief. These will help reduce pain and swelling. Motrin can often be taken every 6 hours. Tylenol can be taken every 4 hours.

  • The provider may tell your child to use ice over where their injury is for the first few days to help with swelling and pain.

  • Physical therapy will start after the first follow-up appointment. This is usually 1 week after surgery.

  • Exercises should be done at home, too. They will help your child’s injury get better and improve their elbow movement.

  • increase in pain, redness, drainage, and swelling

  • nausea, vomiting

  • pain that is not controlled by oral medicines

  • temperature of 101˚ Fahrenheit (F) or 38.8˚ Celsius (C), especially if you have any of the other symptoms above

Activity and Diet

The health care provider will tell you which activities your child should not do. This includes sports or gym class.

Follow-up

  • Your child’s appointment is on (date) _______________ at (time) ___________ in the (place) _____________________________________________________.
  • Your child will have regular follow-up appointments with their provider.
  • Write down all of your questions as you think of them. Bring this list with you when you see the provider.
  • Call your provider if you can’t keep the appointment.

If you have any questions, be sure to ask your health care provider.

 

Ulnar Collateral Ligament (UCL) Injury (PDF)

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