UCL Injuries (the "Tommy John" Injury)
The ulnar collateral ligament (UCL) stabilizes the inner elbow against the stress of throwing. A sprain or tear is the classic overhead-throwing injury that can lead to "Tommy John" surgery.
What is a UCL injury?
The UCL is a ligament on the inner side of the elbow that resists the enormous force generated during overhead throwing. Repetitive throwing gradually wears it down, and it can sprain or tear. It is most familiar in baseball pitchers but occurs in other overhead and throwing athletes too.
Symptoms to watch for
- Pain on the inner side of the elbow, especially during the acceleration phase of throwing
- Loss of throwing velocity or control
- Sometimes a sudden pop during a throw
- Occasionally tingling into the ring and little fingers
How it is diagnosed
A physical exam stresses the ligament to assess stability, and an MRI — often with contrast — shows whether the tear is partial or complete and exactly where it is.
Treatment
Partial tears and lower-demand patients often improve with rest, a structured rehabilitation and throwing program, and in some cases biologic injections. A complete tear in an athlete who wants to return to high-level throwing is typically treated with UCL reconstruction (the "Tommy John" procedure) or, in select cases, repair.
Inner-elbow pain when you throw?
Learn about UCL reconstruction, or schedule an evaluation.
Common questions
Not necessarily. Partial tears often respond to rest and rehab. Complete tears in throwers who want to compete again are where reconstruction is usually recommended.
Partial tears can settle with a careful rehab and throwing program. Complete tears generally do not heal well enough for high-demand throwing on their own.
Return to competitive throwing after reconstruction is a gradual process — often around a year — guided by a stepwise throwing program.
No — that is a myth. It restores stability so an injured athlete can return to their prior level, not beyond it.
This page is for general education and is not a substitute for an in-person evaluation. Your specific diagnosis and treatment plan should come from Dr. Hachadorian based on your exam and imaging.