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Ulnar Collateral Ligament Injury (Tommy John Injury)

Medial UCL valgus instability in overhead athletes: moving valgus/milking exam, stress US/MRI, non-operative rehab, UCL reconstruction (docking/modified-Jobe) and repair with internal brace.

85 citationsUpdated Oct 2026
Illustration: Ulnar Collateral Ligament Injury (Tommy John Injury)

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Ulnar collateral ligament (UCL) injury management has historically relied on expert opinion rather than empirical evidence, with a notable lack of comparative data in the literature [19]. Current evidence for treatment is not convincing, and expert consensus should be viewed with caution due to methodological biases [1]. Future high-quality randomized studies are required to establish definitive standards [1]. While nonoperative treatment can offer favorable outcomes for younger patients with acute or partial injuries [11], professional pitchers with distal tears described on MRI show significantly higher rates of failure with nonoperative management compared to proximal tears [3]. Sonography is capable of identifying UCL injury [12].

Ulnar collateral ligament reconstruction is currently the most commonly performed surgical treatment option for UCL insufficiency [20]. The commonly quoted success rate for reconstruction is 85%, defined as the ability to return to a preinjury level of play for at least one year [20]. Reconstruction based on a hybrid fixation technique results in a low complication rate and allows full recovery to preinjury level of performance in the majority (85%) of patients [6]. Surgical modifications to reconstruction have yielded a decreased postoperative complication rate and improved outcomes compared with prior procedures [18]. In professional baseball players, surgical outcomes are not significantly influenced by reconstruction technique or graft type usage [25].

Primary repair of proximal and distal injuries is a viable alternative in the nonprofessional athlete [5], and primary repair using InternalBrace augmentation seems to have a predictably high rate of clinical success in properly selected patients [39]. Reconstruction with transposition and stabilization of the ulnar nerve, along with appropriate rehabilitation, is effective in correcting medial instability and allows most athletes to return to previous levels of play in less than 1 year [22]. Failing nonsurgical management, reconstruction remains a viable option to return the throwing athlete to competition [4]. Patients with concomitant UCL insufficiency had less optimal outcomes than those with isolated posteromedial impingement [15]. The observed decrease in routine diagnostic arthroscopy utilization with reconstruction over time appears justified, as it does not reduce the need for future valgus extension overload–related surgeries [8]. There is a paucity of literature describing the return-to-competition process after reconstruction in overhead throwing athletes [14].

Anatomy & Pathophysiology

Ligament Anatomy

The anterior bundle of the medial ulnar collateral ligament (UCL) serves as the primary static stabilizer against valgus stress at the elbow [29]. The ligament originates on the distal osteocartilaginous portion of the medial epicondyle apophysis, with its origin center point located approximately 3 mm from the lateral edge of the bony apophysis [29]. It inserts on the medial aspect of the proximal ulna at and just distal to the sublime tubercle [29]. This native insertion site lies deep and anterior to the ulnar nerve [57]. Biomechanical strain patterns differ between the ligament’s bands: the anterior band of the anterior bundle exhibits an isometric strain pattern through the elbow’s range of motion [122], whereas the posterior band demonstrates an increasing strain pattern at higher degrees of elbow flexion [122].

Biomechanics & Pathophysiology

Ulnar collateral ligament injuries result from repetitive valgus forces during throwing [27]. As the primary static constraint of the elbow to valgus stress [58], UCL injury leads to significant functional impairment and secondary intra-articular damage [58]. Specifically, UCL injury increases radiocapitellar contact pressures and reduces the elbow’s resistance to valgus loading [126]. Elbow valgus torque generally increases contact pressure in the radiocapitellar joint [93]. Tearing of the UCL significantly increases elbow valgus laxity, which in turn elongates the ulnar nerve during simulated throwing motion [105].

Injury risk in pitchers likely reflects the combined influence of velocity, workload, biomechanics, recovery, and individual tissue tolerance rather than spin rate alone [82]. Shoulder flexibility, arm speed, and elbow varus torque are interrelated and should be considered collectively when treating pitchers [95]. Elbow valgus torque is poorly suited as a standalone metric for predicting injury risk due to narrow data ranges, modeling noise, and crude assumptions [86]. Ulnar collateral ligament insufficiency is a gradual condition that occurs on a continuum but is often discussed as an all-or-none injury [65]. It remains unclear whether acute worsening of symptoms in UCL insufficiency represents an acute change in pathophysiology or a change in adaptation to longstanding insufficiency [65]. Injury may be preceded by declines in performance and be associated with subsequent injuries to the shoulder and elbow [63]. A reduction in proximal Hounsfield Unit values on CT may reflect localized structural attenuation that is functionally relevant to medial elbow stability [119].

Classification

MRI-Based Classification Systems

Proposed Four-Type MRI System: A proposed MRI-based classification system categorizes ulnar collateral ligament injuries into four types based on severity and location [138]. Type I is defined as edema in the UCL only or a low-grade partial tear [145]. Type II is defined as a partial tear of the UCL with no extravasation of fluid on arthrogram or a high-grade partial tear [145]. Type III is defined as a complete full-thickness tear of the UCL with extravasation of fluid on arthrogram [145]. Type IV is defined as a tear or pathology in more than one location on the UCL, such as the ulna and humerus [145]. Valgus stress opening measurements increased with classification severity in this system: Type I 0.13 mm, Type II 0.20 mm, Type III 0.63 mm, and Type IV 0.76 mm [138]. The prognostic utility of an MRI-based classification for operative versus nonoperative management of ulnar collateral ligament tears was evaluated at one-year follow-up [53].

Six-Stage MRI System: A newly proposed 6-stage MRI-based classification system for UCL tears was assessed for intra- and interobserver reliability [131].

Reliability and Diagnostic Limitations

The interobserver and intraobserver reliability of a newly proposed MRI-based classification system for UCL injuries was assessed using weighted kappa values [131]. Magnetic resonance imaging is not reliable for diagnosing lateral ulnar collateral ligament injuries because an intact ligament often does not appear as a distinct structure and generates artifacts that can be confused with rupture [17]. Preliminary sonographic work provides a framework for developing protocols for diagnosis of injuries to the distal ulnar collateral ligament [16].

Epidemiological and Clinical Classifications

Olecranon Stress Fracture Classification: A classification system for olecranon stress fractures in baseball players identifies five types: physeal, classic, transitional, sclerotic, and distal [135]. The physeal type is further separated into stages 1 to 4 based on severity [135]. The mean age for the physeal type of olecranon stress fracture was 14.1 years and for the classic type was 18.6 years [135].

Elbow UCL Injury Prognosis Score: An Elbow UCL Injury Prognosis Score was developed to identify patient- and injury-specific factors predictive of successful return to play after nonoperative management in baseball players [35]. This score is a close approximation of a logistic regression model developed by recursively selecting features using backward stepwise and best subset methods [35].

Other Considerations: Negative prognostic factors for medial collateral ligament injury include prior elbow surgery, valgus-extension overload syndrome, ulnohumeral chondromalacia, associated flexor-pronator muscle tears, and calcification about the ligament [62].

Clinical Presentation

History and Mechanism

A history of repetitive overuse with throwing is most often present in baseball players with a finding of ulnar collateral ligament injury of the elbow [29]. Significant correlations for this injury include high repetition of in-season throwing, play on multiple teams, positions of pitcher and catcher, and continued play through medial elbow pain [29]. While the ulnar collateral ligament may be injured acutely with a valgus weight-bearing event during upper extremity gymnastic weight bearing or with an elbow dislocation [29], there has been an alarming increase in the incidence of ulnar collateral ligament injuries among youth patients [56]. In other sports, UCL injuries of the elbow are uncommon injuries in professional football quarterbacks [113], and less often, a player may suffer from medial collateral ligament insufficiency in the context of elbow problems in elite tennis players [100].

Physical Examination

The patient with an ulnar collateral ligament injury may present with local tenderness to palpation and loss of elbow extension [29]. Pain with valgus stress tests is common in patients with ulnar collateral ligament injury [29]. Additionally, local pain focally and distal to the ulnar collateral ligament origin and extending to the sublime tubercle region is common in patients with ulnar collateral ligament injury [29]. The clinician caring for the overhead throwing athlete must combine a thorough history, comprehensive physical examination, and judicious diagnostic imaging to confirm UCL injury and rule out alternative or concomitant medial elbow pathology [61].

Imaging

Plain radiographs may often show chronic changes of valgus stress in the ulnar collateral ligament injured elbow [29]. In the case of a partial or osteocartilaginous sleeve avulsion, a radiodense fragment or fleck may be identified on radiographs [29]. Ultrasound or MRI may be employed to investigate the soft tissue portion of the ulnar collateral ligament [29]. MRI with joint arthrogram is most commonly used to investigate the soft tissue portion of the ulnar collateral ligament [29]. A low-grade (I or II) partial injury of the ulnar collateral ligament may be difficult to definitively assess on MRI [29], whereas complete mid-substance or origin, insertional injuries (III) of the ulnar collateral ligament may be more clear on MRI [29]. Magnetic resonance imaging is not reliable for diagnosing lateral ulnar collateral ligament injuries at the present time because an intact ligament often does not appear as a distinct structure and generates artifacts that can be confused with rupture [17]. Thickening of the medial ulnar collateral ligament in the throwing arm of asymptomatic and uninjured players may begin by the time the players reach high school [26]. Changes present in the UCL and detectable on ultrasound may help distinguish elbows at risk for later clinical UCL insufficiency [60]. The ulnar collateral ligament responds to stress in professional pitchers [40] and responds to stress and rest in professional pitchers [115].

Prognostic Factors and Comorbidities

Combined flexor-pronator and ulnar collateral ligament injuries in baseball players may portend a worse prognosis, with a 12.5% return to prior level of play [98]. Dominant arm total arc of motion, external, or internal rotation range of motion were not risk factors for ulnar collateral ligament injury [24].

Investigations

Plain radiography: Plain radiographs may demonstrate chronic changes of valgus stress in the elbow [29]. In cases of partial injury or osteocartilaginous sleeve avulsion, a radiodense fragment or fleck may be identified on plain films [29]. Stress radiography does not provide a numerical value that can confidently determine the pathologic status of the ulnar collateral ligament [132].

MRI: MRI with joint arthrogram is the most commonly used imaging modality to investigate the soft tissue portion of the ulnar collateral ligament [29]. Complete mid-substance or origin and insertional injuries (Grade III) are more clearly identified on MRI than low-grade (Grade I or II) partial injuries [29].

Ultrasound: Valgus stress ultrasound is useful for identifying complete medial ulnar collateral ligament tears but is less sensitive for detecting partial tears [133]. Changes present in the ulnar collateral ligament and detectable on ultrasound may help distinguish elbows at risk for later clinical ulnar collateral ligament insufficiency [60].

Arthroscopy: Arthroscopic techniques provide safe and objective means to evaluate and diagnose both medial and lateral elbow instability, despite being more invasive than ultrasonography and radiography [134].

Other Considerations: Definitive complete injury of the ulnar collateral ligament requires correlation of history, physical exam, imaging, and often failure of return to sport [29]. The quality of ulnar collateral ligament-related information on YouTube is low, with differential diagnoses, accurate surgical indications, and thorough discussions of adverse outcomes being the most lacking information [13].

Treatment

Non-Operative

Non-operative management of ulnar collateral ligament (UCL) injuries is guided primarily by expert opinion rather than empirical evidence, with a notable lack of comparative data in the literature [19]. Conservative treatment involves a minimum of three months’ rest with rehabilitation exercises, which allows return to the previous level of competition in 42% of athletes [46]. Those who successfully return to competition do so at an average of 24.5 weeks after diagnosis [46]. A systematic review reports a mean return-to-sport time of 91.9 ± 46.2 days (13.1 weeks; range, 1–54 weeks) following non-operative management [70]. Overall return-to-play rates after conservative treatment of partial UCL injuries in overhead athletes range between 42% and 100%, with a mean of 78% ± 20% [77]. The most frequently reported components of rehabilitation protocols include a period of rest, stretching, strengthening, and a throwing program [77].

Non-operative treatment is likely to be more successful in younger players, lower grade tears, and humeral-sided injuries [130]. Incomplete UCL injuries in professional baseball players can be successfully treated nonoperatively in the majority of cases [149], and UCL injuries in high school baseball players can be successfully treated nonoperatively in most cases [147]. In professional pitchers undergoing initial nonoperative treatment, 34% failed and required subsequent ligament reconstruction, while 66% successfully returned to the same level of play for one year without surgical intervention [52]. No findings obtained through history or physical examination in a specific study cohort assisted in predicting the success of nonoperative treatment [46], and there was no significant difference in physical examination findings or performance metrics between professional pitchers who succeeded and those who failed nonoperative management [52]. Both operative and non-operative treatments can be offered as successful treatment options for UCL injuries in gymnasts [142]. There is no current consensus regarding the true efficacy of platelet-rich plasma therapy in patients with partial UCL tears [75], and no consensus exists regarding the utilization of autologous stem cell treatments due to a lack of clinical investigations [75].

Operative

Indications: Surgical management is indicated when the elbow remains unstable, with the lateral ulnar collateral ligament being the most critical structure to repair or reconstruct [9]. It remains unclear which patients are the ideal candidates for UCL reconstruction versus repair [74]. The number of UCL reconstructions being performed has risen sharply in recent years, most notably in the young amateur athlete [47], with a 193% increase in New York State between 2002 and 2011 [47]. UCL injuries are becoming increasingly common in adolescent athletes, especially baseball pitchers, gymnasts, and others [74].

Surgical Approach / Technique: UCL reconstruction is currently the most commonly performed surgical treatment option for UCL insufficiency, with a commonly quoted success rate of 85% defined as the ability to return to a preinjury level of play for at least one year [20]. Reconstruction based on a hybrid fixation technique results in a low complication rate and allows full recovery to preinjury level of performance in the majority (85%) of patients [6]. Reconstruction utilizing the docking technique results in a significantly higher rate of return to play and a lower complication rate when compared with the Jobe and modified Jobe techniques [42]. A series of modifications to the original Jobe reconstruction technique have been proposed, with collective studies noting 81% to 92% good-to-excellent results with 78% to 90% return to activities [72]. Reconstruction with subcutaneous ulnar nerve transposition was found to be effective in correcting valgus elbow instability in the overhead athlete and allowed most athletes (83%) to return to previous or higher level of competition in less than 1 year [108]. Reconstruction with transposition and stabilization of the ulnar nerve and appropriate rehabilitation was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year [22]. Surgical modifications specifically involving a muscle-splitting approach without transposition of the ulnar nerve yielded a decreased postoperative complication rate and improved outcomes compared with prior procedures [18]. Advances in the surgical technique of UCL reconstruction have minimized postoperative complications [148].

Repair and Augmentation: UCL repair has favorable outcomes in select patients with specific tear type patterns [71]. Clinical outcomes of UCL repair have shown return to play rates of 92–97% with a mean time of 2.5–6 months post-operatively [71]. Biomechanical data comparing UCL repair to reconstruction techniques have shown improved resistance to common forces applied to the elbow during overhead activities [71]. Suture tape augmentation dramatically improves stability of ligament repair without over-constraining the elbow [71]. UCL repair with suture tape augmentation has been substantiated by research to have high levels of good-to-excellent outcomes and notably quicker return to sport compared with UCL reconstruction [72]. The conundrum of reconstruction or repair has challenged elbow surgeons for more than half a century, with primary repair being the only surgical option until 1974 [72]. Primary UCL repair was largely abandoned for an extended period of time in favor of reconstruction following initial outcomes showing statistically greater results with reconstruction [72]. UCL repair with an internal brace allows full activity at 6 months and participation in contact sports at 1 year [10]. For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures [41]. No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament between acute and delayed treatment cohorts [2].

Other Considerations: The success rate of UCL reconstruction in high school baseball players is nearly equal to that in more mature groups of throwers [97]. Both UCL reconstruction and UCL repair show favorable outcomes at minimum two-year follow-up in non-throwing athletes, with 93% or greater returning to play with good functional outcomes and minimal complications [43]. Clinical outcomes following UCL procedures in non-baseball throwing athletes include a 92% return to play rate and high surgical satisfaction and functional outcome scores [151]. Most athletes are able to return to a high level of competition following surgical treatment of medial elbow injuries [148]. Low-level, high-bias evidence demonstrates that the overall return to sport proportion is higher than return to sport at previous level, regardless of treatment type for UCL injury [64]. Routine diagnostic arthroscopy with elbow UCL reconstruction does not reduce the need for future valgus extension overload–related surgeries [8]. There was no difference in return to play rate following UCL reconstruction in baseball players with and without posteromedial impingement treated with arthroscopic resection [120]. Posteromedial osteophyte resection in baseball players undergoing UCL reconstruction decreases patient-reported satisfaction and throwing control [120]. The current evidence for UCL injury treatment is not convincing, and while expert consensus provides guidance, it should be viewed with caution due to methodological biases [1]. Efforts for physicians to educate the media on the risks of overuse throwing injuries with emphasis on the indications, outcomes, and recovery of Tommy John surgery are encouraged [30].

Complications

Nerve palsy: Ulnar nerve complications are a documented outcome following ulnar collateral ligament reconstruction of the elbow [21]. Surgical modifications to the reconstruction procedure, specifically a muscle-splitting approach without transposition of the ulnar nerve, yielded a decreased postoperative complication rate compared with prior procedures [18].

Heterotopic ossification: Symptomatic heterotopic ossification is a documented clinical complication following ulnar collateral ligament reconstruction [21].

Graft site morbidity: Graft site morbidity is a documented complication in elbow ligament reconstruction procedures [21].

Other Considerations: Ulnar collateral ligament reconstruction utilizing the docking technique results in a lower complication rate when compared with the Jobe and modified Jobe techniques [42]. In non-throwing athletes, both UCL reconstruction and UCL repair show minimal complications at minimum two-year follow-up [43].

Recovery

Full activity (months): For ulnar collateral ligament repair with an internal brace, full activity is allowed at 6 months [10]. Participation in contact sports is permitted at 1 year [10].

Range of Motion: Following UCL repairs and reconstructions, elbow range of motion is reliably preserved or improved with a predictable trajectory of rapid improvement within the first 2 to four months [55].

Functional milestones: Ulnar collateral ligament reconstruction is currently the most commonly performed surgical treatment option for UCL insufficiency, with a commonly quoted success rate of 85% defined as the ability to return to a preinjury level of play for at least one year [20]. Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels [154]. Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return [153].

Other Considerations: Both UCL reconstruction and UCL repair show favorable outcomes at minimum two-year follow-up in non-throwing athletes [43]. In non-throwing athletes undergoing UCL reconstruction or repair, 93% or greater returned to play with good functional outcomes and minimal complications [43]. Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes [144]. Surgical modifications to the ulnar collateral ligament reconstruction yielded a decreased postoperative complication rate and improved outcomes compared with the results of prior procedures [18].

Key Evidence

  • [L5] The current evidence for ulnar collateral ligament injury treatment is not convincing, and while expert consensus provides guidance, it should be viewed with caution due to methodological biases; future high-quality randomized studies are required. [1] (10.1016/j.arthro.2023.02.003)
  • [L3] No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament between acute and delayed treatment cohorts. [2] (10.1016/j.jhsa.2014.02.011)
  • [L3] In professional pitchers, distal ulnar collateral ligament tears described on MRI show significantly higher rates of failure with nonoperative management compared to proximal tears. [3] (10.1177/2325967116s00169)
  • [L5] Failing nonsurgical management, ulnar collateral ligament reconstruction is a viable option to return the throwing athlete to competition. [4] (10.5435/jaaos-22-05-315)
  • [L4] Primary repair of proximal and distal injuries of the medial ulnar collateral ligament is a viable alternative in the nonprofessional athlete. [5] (10.1177/0363546508315201)
  • [L4] Ulnar collateral ligament reconstruction based on a hybrid fixation technique results in a low complication rate and allows full recovery to preinjury level of performance in the majority (85%) of patients. [6] (10.1177/0363546510385401)
  • [L1] The observed decrease in routine diagnostic arthroscopy utilization with ulnar collateral ligament reconstruction over time appears justified based on these findings. [8] (10.1016/j.jse.2021.08.004)
  • [L5] Surgical management is indicated when the elbow remains unstable, with the lateral ulnar collateral ligament being the most critical structure to repair or reconstruct. [9] (10.1016/j.hcl.2016.08.003)
  • [L5] Nonoperative treatment can offer favorable outcomes for younger patients with acute or partial ulnar collateral ligament injuries. [11] (10.1016/j.otsm.2020.150733)
  • [L4] Sonography can identify injury of the ulnar collateral ligament. [12] (10.1007/s00256-002-0558-0)
  • [L4] The quality of ulnar collateral ligament-related information on YouTube is low, with differential diagnoses, accurate surgical indications, and thorough discussions of adverse outcomes being the most lacking information. [13] (10.1016/j.asmr.2023.100769)
  • [L4] There is a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. [14] (10.1177/03635465211016839)
  • [L4] Patients with concomitant ulnar collateral ligament insufficiency had less optimal outcomes than those with isolated posteromedial impingement. [15] (10.1016/j.jse.2016.09.007)
  • [L4] This preliminary work provides a framework for developing protocols for diagnosis of injuries to the distal ulnar collateral ligament. [16] (10.7863/ultra.33.8.1485)
  • [L4] Magnetic resonance imaging is not reliable for diagnosing lateral ulnar collateral ligament injuries at the present time because an intact ligament often does not appear as a distinct structure and generates artifacts that can be confused with rupture. [17] (10.1016/j.jse.2003.12.013)
  • [L4] These surgical modifications to the ulnar collateral ligament reconstruction yielded a decreased postoperative complication rate and improved outcomes compared with the results of prior procedures. [18] (10.1067/mse.2001.112881)
  • [L5] Management of lateral elbow epicondylalgia and medial ulnar collateral ligament injury has been guided mostly by expert opinion rather than empirical evidence, with a lack of comparative data in the literature. [19] (10.1016/j.jse.2023.07.034)
  • [L4] Ulnar collateral ligament reconstruction is currently the most commonly performed surgical treatment option for UCL insufficiency, with a commonly quoted success rate of 85% defined as the ability to return to a preinjury level of play for at least one year. [20] (10.1136/bjsm.2005.025072)
  • [L4] Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year. [22] (10.1177/03635465000280011401)
  • [L2] Dominant arm total arc of motion, external, or internal rotation range of motion were not risk factors for ulnar collateral ligament injury. [24] (10.1016/j.jse.2018.08.018)
  • [L3] Surgical outcomes in professional baseball players are not significantly influenced by ulnar collateral ligament reconstruction technique or graft type usage. [25] (10.1177/2325967118s00087)
  • [L4] Thickening of the medial ulnar collateral ligament in the throwing arm of asymptomatic and uninjured players may begin by the time the players reach high school. [26] (10.1007/s10396-014-0605-1)
  • [L5] This article reviews the anatomy, biomechanics, pathophysiology, diagnosis, and treatment options for ulnar collateral ligament injuries in overhead athletes, emphasizing that the injury is not uncommon and results from repetitive valgus forces during throwing. [27] (10.1016/j.csm.2004.05.002)
  • [L3] Efforts for physicians to educate the media on the risks of overuse throwing injuries with emphasis on the indications, outcomes, and recovery of Tommy John surgery are encouraged. [30] (10.1080/00913847.2015.1077098)
  • [L4] The use of suture button fixation for repair of lateral ulnar collateral ligament has not been previously described. [32] (10.1016/j.eats.2023.10.004)
  • [L3] [35] (10.1177/03635465251366318)
  • [L5] Primary repair of the ulnar collateral ligament (UCL) using InternalBrace augmentation seems to have a predictably high rate of clinical success in properly selected patients. [39] (10.1016/j.csm.2020.04.001)
  • [L3] The ulnar collateral ligament responds to stress in professional pitchers. [40] (10.1177/2325967119s00372)
  • [L4] For complex elbow instability, ligament repair with suture-tape augmentation of the lateral ulnar collateral ligament results in acceptable functional outcomes and a reoperation rate comparable with other joint stabilization procedures. [41] (10.1016/j.jhsa.2022.10.016)
  • [L4] Ulnar collateral ligament reconstruction utilizing the docking technique results in a significantly higher rate of return to play and a lower complication rate when compared with the Jobe and modified Jobe techniques. [42] (10.1177/0363546513509051)
  • [L4] Both UCL reconstruction and UCL repair show favorable outcomes at minimum two-year follow-up in non-throwing athletes. 93% or greater returned to play with good functional outcomes and minimal complications. [43] (10.1177/2325967121s00551)
  • [L4] [46] (10.1177/03635465010290010601)
  • [L5] [47] (10.1177/0363546517692548)
  • [L3] [52] (10.1177/0363546517699832)
  • [L4] [53] (10.1016/j.jse.2018.11.063)
  • [L4] Following UCL repairs and reconstructions, elbow ROM is reliably preserved or improved with a predictable trajectory of rapid improvement within the first 2 to four months. [55] (10.1016/j.jse.2025.10.002)
  • [Paper] There has been an alarming increase in the incidence of ulnar collateral ligament (UCL) injuries among youth patients. [56] (10.2106/jbjs.rvw.25.00060)
  • [L4] The ulnar collateral ligament is the primary static constraint of the elbow to valgus stress, and injuries can lead to significant functional impairment and secondary intra-articular damage. [58] (10.1111/sae.12014)
  • [L2] Our data suggests that changes present in the UCL and detectable on ultrasound may help distinguish elbows at risk for later clinical UCL insufficiency. [60] (10.1177/2325967115s00162)
  • [L5] The clinician caring for the overhead throwing athlete must combine a thorough history, comprehensive physical examination, and judicious diagnostic imaging to confirm UCL injury and rule out alternative or concomitant medial elbow pathology. [61] (10.1016/j.csm.2020.02.002)
  • [L5] [62] (10.2106/jbjs.rvw.m.00057)
  • [L4] Injury may be preceded with declines in performance and be associated with subsequent injuries to the shoulder and elbow. [63] (10.1177/2325967117s00217)
  • [L1] Low-level, high-bias evidence demonstrates overall return to sport proportion is higher than return to sport at previous level, regardless of treatment type for ulnar collateral ligament injury. [64] (10.1016/j.jse.2017.12.003)
  • [L5] [65] (10.1016/j.jhsa.2014.04.011)
  • [L3] [70] (10.1177/17585732241235631)
  • [L4] [71] (10.1007/s12178-021-09698-4)
  • [L5] [72] (10.1016/j.arthro.2025.01.017)
  • [L5] [74] (10.1016/j.arthro.2022.12.033)
  • [L4] [75] (10.1007/s12178-020-09637-9)
  • [L4] [77] (10.1177/1941738119853589)
  • [L4] Elbow injury risk in pitchers likely reflects the combined influence of velocity, workload, biomechanics, recovery, and individual tissue tolerance rather than spin rate alone. [82] (10.1177/2325967126s00497)
  • [L5] Elbow valgus torque is poorly suited as a standalone metric for predicting injury risk due to narrow data ranges, modeling noise, and crude assumptions; future efforts should focus on integrated, longitudinal metrics rather than single-session proxies. [86] (10.1002/arj.70098)
  • [L5] Elbow valgus torque increases contact pressure in the radiocapitellar joint. [93] (10.1177/0363546513490652)
  • [L4] Shoulder flexibility, arm speed, and elbow varus torque are interrelated and should be considered collectively when treating pitchers. [95] (10.1177/0363546517719047)
  • [L3] The success rate of ulnar collateral ligament reconstruction in high school baseball players is nearly equal to that in more mature groups of throwers. [97] (10.1177/0363546503262166)
  • [L4] Combined flexor-pronator and ulnar collateral ligament injuries in baseball players may portend a worse prognosis, with a 12.5% return to prior level of play. [98] (10.1177/0363546509351558)
  • [Paper] Less often, a player may suffer from ulnar nerve or posterior interosseous nerve entrapment or medial collateral ligament insufficiency. [100] (10.1097/00132589-200306000-00004)
  • [L5] Tearing of the UCL significantly increased elbow valgus laxity, which in turn elongated the ulnar nerve during simulated throwing motion. [105] (10.1016/j.jse.2019.02.009)
  • [L4] Ulnar collateral ligament reconstruction with subcutaneous ulnar nerve transposition was found to be effective in correcting valgus elbow instability in the overhead athlete and allowed most athletes (83%) to return to previous or higher level of competition in less than 1 year. [108] (10.1177/0363546510378100)
  • [L4] UCL injuries of the elbow are uncommon injuries in professional football quarterbacks. [113] (10.1016/j.jse.2010.05.028)
  • [L3] The ulnar collateral ligament responds to stress and rest in professional pitchers. [115] (10.1177/2325967120s00130)
  • [L3] A reduction in proximal HU values may reflect localized structural attenuation that is functionally relevant to medial elbow stability. [119] (10.1177/23259671261472961)
  • [L3] There was no difference in return to play rate following ulnar collateral ligament reconstruction in baseball players with and without posteromedial impingement treated with arthroscopic resection. [120] (10.1016/j.asmr.2023.04.012)
  • [L5] The anterior band of the anterior bundle of the UCL shows an isometric strain pattern through elbow range of motion, while the posterior band shows an increasing strain pattern in higher degrees of elbow flexion. [122] (10.1007/s00167-014-3482-7)
  • [L5] UCL injury increases radiocapitellar contact pressures and reduces resistance of the elbow to valgus loading. [126] (10.1016/j.jse.2010.09.011)
  • [L3] Non-operative treatment of UCL injuries will likely be more successful in younger players, lower grade tears, and humeral-sided injuries. [130] (10.1177/2325967119s00311)
  • [L2] [131] (10.1177/0363546518786970)
  • [L3] No numerical value can confidently determine the pathologic status of the ulnar collateral ligament of the elbow when using stress radiography. [132] (10.1177/03635465010290050601)
  • [L3] Valgus stress ultrasound is useful for identifying complete medial ulnar collateral ligament tears but is less sensitive for detecting partial tears. [133] (10.1016/j.jse.2019.12.005)
  • [Paper] Despite the invasive nature of arthroscopy in comparison to modalities such as ultrasonography and radiography, these described techniques provide safe and objective means to evaluate and diagnose both medial and lateral elbow instability. [134] (10.1016/j.eats.2023.04.029)
  • [L4] [135] (10.1177/0363546514528099)
  • [L4] [138] (10.1016/j.jse.2016.05.006)
  • [L4] Both operative and non-operative treatments can be offered as successful treatment options for UCL injuries in gymnasts. [142] (10.1177/2325967121s00200)
  • [L4] Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes. [144] (10.1177/0363546520934778)
  • [L4] [145] (10.1177/03635465221150507)
  • [L3] UCL injuries in high school baseball players can be successfully treated nonoperatively in most cases. [147] (10.1016/j.jse.2020.09.022)
  • [L5] Advances in the surgical technique of UCL reconstruction have minimized postoperative complications, and most athletes are able to return to a high level of competition following both nonoperative and surgical treatment of medial elbow injuries. [148] (10.1016/j.hcl.2016.08.013)
  • [L4] Incomplete UCL injuries in professional baseball players can be successfully treated nonoperatively in the majority of cases. [149] (10.1177/0363546515621756)
  • [L4] We identified excellent clinical outcomes following UCL procedures in non‐baseball throwing athletes with a 92% return to play rate and high surgical satisfaction and functional outcome scores. [151] (10.1177/2325967121s00577)
  • [L4] Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return. [153] (10.1016/j.arthro.2023.09.030)
  • [L2] Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels. [154] (10.1177/0363546506296737)

See Also

References

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For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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