Ulnar collateral ligament, or UCL, injuries happen when the elbow goes through too much repeated stress. These injuries are common in people involved in throwing sports or do frequent overhead work. These injuries are becoming more common among young athletes who play only one sport all year. Doing the same motions over and over can strain muscles and joints, leading to injury.

UCL injuries are often called “Tommy John” injuries. The name comes from a well-known baseball pitcher who had the first surgery to repair this ligament in 1974. Physical therapists can help people recover from or avoid UCL injuries. They look at what a sport or job requires help people build strength and improve technique. Physical therapists also can help reduce pain, address muscle imbalances, and guide a safe return to play or work.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT. 

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On this page

• What Are Ulnar Collateral Ligament Injuries?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Are Ulnar Collateral Ligament Injuries?

The ulnar collateral ligament is a strong band of connective tissue that connects your upper arm bone (the humerus) to one of your forearm bones (the ulna). This ligament helps keep your elbow stable, especially during overhead activity like throwing a ball. 

A UCL injury happens when the ligament is stretched (sprained) or torn. A sprain is when a ligament stretches beyond its normal length. It can happen from doing the same overhead motion repeatedly, like pitching in baseball or painting a ceiling. A sprain can become a partial or complete tear if a person doesn't give their elbow time to rest and heal. A tear also can result from direct trauma to the elbow, like falling on an outstretched hand. A person with a UCL sprain will feel pain at the inner elbow. With a tear, you can feel like your elbow is loose or unstable.

In severe cases, with an unstable elbow or difficulty returning to full activity, surgery may be necessary.

Signs and Symptoms

The symptoms of a UCL injury depend on how severe it is. Symptoms may include: 

• Soreness or tightness along the inside of your elbow.

• Sharp pain during throwing or overhead movement.

• Mild swelling and possible bruising along the inside of your elbow.

• Possible numbness and tingling in the pinky and ring finger. 

• Instability at your elbow joint (feels like your elbow may "give out" with certain movements).

• A pop or click in the arm with throwing or bending the elbow. 

• Pain when using your arm in an overhead position (such as throwing/pitching a ball or swinging a racquet). 

• Difficulty warming up for a sport or needing a longer time to warm up.

• A change in sports performance (such as a decrease in pitching speed). 

How Is It Diagnosed?

How Can a Physical Therapist Help?

Your physical therapist can help improve your arm's strength and range of motion following a UCL injury. They also can help restore your shoulder and core stability, coordination, and balance. Your physical therapist will design a program to make sure your body is prepared to handle the demands of your sport or job.

Preventing Injuries in Overhead Sports 

Some physical therapists offer programs for overhead athletes and workplace health. These programs help to ensure your body is prepared to handle the demands of your sport or job by testing your mobility and strength, assessing the demands of your activities, and designing a plan tailored to you.

Overhead sports and physically demanding jobs use whole-body, coordinated movement. In addition to arm and shoulder strength, they require abdominal, low back, and leg strength, as well as mobility. Physical therapists are experts at identifying movement faults or strength deficits and can help you stay in the game and ready for work.

Healing From a UCL injury 

If you hurt your elbow, a physical therapist can help you recover, understand why it happened, and teach you how to avoid getting hurt again. Your physical therapy program will be designed to: 

Promote healing. To help your UCL heal, you’ll need to rest and avoid activities that stress your elbow. You might wear a brace to protect it. Your physical therapist may also use hands-on treatments, such as soft-tissue massage, to reduce pain and support tissue healing. 

Build strength. Sometimes, the muscles in your forearm are strained too. At first, your therapist will use light exercises to help these muscles heal. Later, your physical therapist will guide you through more challenging exercises to strengthen your arm, shoulder, and your legs and core. Building strength in these areas enables full-body support for your overhead movements. 

Improve range of motion. After resting or wearing a brace, your elbow might feel stiff. Your physical therapist will help you get your normal movement back using stretches, exercises, and hands-on techniques. They’ll also check your shoulder strength and range of motion, as these are essential for overhead activity.

Improve movement. Sports and jobs that use your arm overhead need your whole body to work together. Your physical therapist will assess how you move and help address anything that could lead to injury. They’ll create a plan to help you safely return to your sport or activity. 

Get you ready for play or work again. Before you go back to your sport or job duties, your physical therapist will help your elbow get used to activity again. They’ll guide you through a step-by-step program to make sure you’re ready for practice and competition or a demanding workload. 

If Surgery Is Needed 

People who sprain or partially tear their UCL often improve with rest, a brace, and physical therapy. But sometimes, if the pain doesn’t go away, surgery might be needed. This is especially for people who must do repeated overhead activity. If the ligament is completely torn, surgery and physical therapy are usually required to return to the demands of your sport or job.

After surgery, a physical therapist will follow your surgeon’s protocol and help you recover. Right after surgery, your arm will likely be placed in a splint, brace, or sling to help keep it safe. Physical therapy usually starts within two weeks. It will help you:

• Follow a safe recovery plan. You’ll get a personalized program to help you heal from surgery.

• Protect your elbow. You will wear a brace for five to six weeks to allow your arm to heal from surgery (your surgeon may adjust this time). You will learn how often to remove the brace for exercise and how to safely move your arm while it is out of the brace.

• Improve movement. As you heal, your physical therapist will help stretch and move your arm and shoulder. 

• Build strength. Your physical therapist will start you with exercises to strengthen your hand and forearm. Later, you’ll work on your shoulder and upper back muscles to prepare for overhead activity. 

• Get ready for sports again. As you heal and your protocol allows, your exercises will become more focused on the specific activity you want to return to. 

After surgery patients can expect a slow return to competion that may follow these timelines:

• Light throwing. You can usually start gentle throwing or limited overhead lifting and work activities about six months after surgery, but only if your doctor and physical therapist clear you first. 

• Full competition. Most athletes can return to full games around 12 to 14 months after surgery. This depends on how well you heal and how quickly you get stronger. Don’t play in competitive games until your doctor and physical therapist give you the green light.

Can This Injury or Condition Be Prevented?

Overhead activity requires a great deal of movement coordination. When you repeatedly perform a movement with a lot of effort, such as throwing a ball or doing construction work, your muscles can get tired. This may cause your body to move differently, leading to strain in your forearm muscles and stress on your elbow. With proper regular rest, your body can recover and be ready to do the activity safely again. When muscles don’t recover from prior fatigue, stress at the elbow accumulates and can lead to injury over time. Physical therapists can help by checking your strength and flexibility. They’ll teach you how to fix any problems so you can avoid getting hurt.

Prevention Tips for Athletes

Pitching and throwing mechanics are well studied. Changes in the positioning of the shoulder, elbow, and legs can impact your throwing mechanics. Physical therapists can improve your performance and help you avoid injuries.

Here are some tips to avoid pitching injuries:

• Follow pitch count rules by Little League Baseball.

• Don’t pitch if your elbow or shoulder hurts.

• Avoid playing on multiple teams with overlapping seasons.

• Don’t pitch two days in a row.

• Play a variety of sports throughout the year.

• Focus on your pitching form, not your speed.

Prevention Tips for People with Jobs Requiring Overhead Work

• Do different types of tasks during the day, not just overhead work.

• Try not to do overhead work multiple days in a row.

• Pay attention to how tired your arm feels and take breaks when needed.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat UCL injuries. However, you may want to consider: 

• A physical therapist who is experienced in treating people with UCL injuries. Some physical therapists have a practice that focuses on sports and orthopedics, or injuries of the arm and shoulder. 

• A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in sports or orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition. 

You can search for physical therapists near you who meet these criteria by using Find a PT, provided by the American Physical Therapy Association. 

General tips when you're looking for a physical therapist (or any other health care provider): 

• Ask family, friends, or other health care providers to recommend a physical therapist. 
• Ask about the physical therapists' experience in helping people with UCL injuries when you contact the clinic for an appointment. 
• Be prepared to describe your symptoms in as much detail as possible. Make a note of what makes your symptoms better or worse.