What is Ulnar Collateral Ligament Injury

Ulnar collateral ligament injury is a type of elbow injury that develops from repeated overhand throwing movements (overuse). This motion places a lot of stress on the two strong bands of tissue (ligaments) that hold your elbow joint in place. The ulnar collateral ligament (UCL) is a main ligament that is located on the inside of your elbow. Over time, repetitive overhand throwing can damage the UCL.

This injury is common in athletes who make repeated overhead motions. UCL injuries can range from minor inflammation to a complete ligament tear.

What are the causes?

This condition is caused by:

• Continuous or repetitive overhand throwing, such as baseball pitching.
• Falling onto your elbow or outstretched arm.

What increases the risk?

This condition is more likely to develop in athletes who play sports that involve repetitive overhand throwing or a similar motion. Baseball pitchers have a high risk, especially those who are able to throw the ball hard and fast. Other sports associated with this injury include:

• Tennis and other racquet sports.
• Football.
• Lacrosse.
• Gymnastics.
• Javelin throwing.
• Ice hockey.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain on the inside of your elbow.
• Limited range of motion in your elbow.
• Popping or tearing sensation in your elbow.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and physical exam. During the exam, your health care provider will check the range of motion, strength, and stability of your elbow. Your health care provider may also gently press your arm and elbow to find the source of pain. You may also have imaging studies, such as:

• X-rays to rule out other causes of elbow pain.
• Ultrasound or MRI to check for tears in the ligaments or tendons.

How is this treated?

Treatment for this condition depends on the severity. Treatment for minor UCL injuries may include:

• Taking an NSAID to relieve pain.
• Limiting activities that cause elbow pain, then gradually returning to full activities.
• Doing strength and range-of-motion exercises (physical therapy) as told by your health care provider.
• Changing position and body mechanics for throwing.

You may need surgery if other treatments do not help, if you have recurring instability in the elbow, or if you have a complete tear of the UCL. After surgery, you will have to wear a cast or splint, and you will eventually have physical therapy.

Follow these instructions at home:

Managing Pain, Stiffness, and Swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a damp towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General Instructions

• Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not use the injured limb to support your body weight until your health care provider says that you can.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.
• Avoid constant participation in any one sport. Play other sports that do not involve overhead throwing.
• Work with a coach to get trained in proper body mechanics and throwing technique.
• Stop throwing if your elbow feels weak or unstable.
• Never play through pain.

Contact a health care provider if:

• Your pain does not improve or it gets worse.

Get help right away if:

• Your pain is severe.
• You cannot move your arm or elbow.

Ulnar Collateral Ligament Injury of the Elbow, Phase I Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Elbow extension, active and active-assisted

1. Hold your left / right arm at your side, and straighten your elbow as much as you can using your left / right arm muscles.
2. If told by your healthcare provider, straighten the left / right elbow farther by gently pushing down on your forearm using your other hand until you feel a gentle stretch.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Elbow flexion, active and active-assisted

1. Hold your left / right arm at your side, and bend your elbow as much as you can using your left / right arm muscles.
2. If told by your healthcare provider, bend the left / right elbow farther by gently pushing up on your forearm using your other hand until you feel a gentle stretch.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Forearm rotation, supination, active

1. Stand or sit with your elbows at your sides.
2. Bend your left / right elbow to an “L” shape (90 degrees).
3. Turn your palm upward until you feel a gentle stretch on the inside of your forearm.
4. Hold this position for __________ seconds.
5. Slowly release and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Forearm rotation, pronation, active

1. Stand or sit with your elbows at your sides.
2. Bend your left / right elbow to an “L” shape (90 degrees).
3. Turn your palm downward until you feel a gentle stretch on the top of your forearm.
4. Hold this position for __________ seconds.
5. Slowly release and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Elbow flexion, supine, passive

1. Lie on your back.
2. Extend your left / right arm up into the air toward the ceiling, bracing it with your other hand.
3. Let your left / right elbow bend, allowing your hand to fall slowly toward your shoulder.
4. You should feel a gentle stretch along the back of your upper arm or elbow, or both. Your health care provider may have you hold a __________ hand weight to increase the intensity of this stretch.
5. Hold this position for __________ seconds.
6. Slowly return your left / right arm to the upright position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Elbow extension, supine, passive

1. Lie on your back. Make sure that you are in a comfortable position that lets you relax your muscles.
2. Place a folded towel under your left / right upper arm so your elbow and shoulder are at the same height.
3. Extend your left / right arm so your elbow does not rest on the bed or towel.
4. Let the weight of your hand straighten your elbow. Keep your arm and chest muscles relaxed.
5. Your health care provider may have you increase the intensity of your stretch by adding a small wrist weight or hand weight.
6. Hold this position for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Ulnar Collateral Ligament Injury of the Elbow, Phase II Rehab

These exercises are more advanced than phase I exercises. Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Strengthening exercises

These exercises build strength and endurance in your elbow. Endurance is the ability to use your muscles for a long time, even after they get tired. Your healthcare provider will instruct you when it is safe and appropriate for you to begin these exercises.

Exercise A: Elbow flexors, pronation

1. Sit upright on a firm chair without armrests, or stand.
2. Let your left / right arm rest at your side with your palm facing forward.
3. Holding a __________ weight or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.
4. Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Elbow flexors, neutral

1. Sit upright on a firm chair without armrests, or stand.
2. Let your left / right arm rest at your side with your thumb facing forward.
3. Holding a __________ weight or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.
4. Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Elbow extensors

1. Lie on your back. Extend your left / right elbow up into the air, pointing it toward the ceiling. Brace your arm with your other hand. Or, you may do this exercise by standing with your elbow over your head so it is pointed toward the ceiling and supported by your other hand.
2. Holding a __________ weight in your left / right hand, slowly straighten your left / right elbow.
3. Allow your muscles to control the weight as your hand returns to its starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Elbow extensors, dynamic

1. Sit upright on a firm chair without armrests, or stand.
2. Keep your upper arms at your sides, and bring both hands up to your left / right shoulder while gripping a rubber exercise band or tubing. Your left / right hand should be just below the other hand.
3. Straighten your left / right elbow.
4. Hold this position for __________ seconds.
5. Control the rubber exercise band or tubing as your hand returns to your shoulder.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Wrist flexors

1. Sit with your left / right forearm palm-up and supported on a table or other surface. Your elbow should be resting below the height of your shoulder.
2. Let your wrist extend over the edge of the surface.
3. Loosely holding a __________ weight or a piece of rubber exercise band or tubing, slowly curl your left / right hand up toward your forearm.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Wrist extensors

1. Sit with your left / right forearm palm-down and supported on a table or other surface. Your elbow should be resting below the height of your shoulder.
2. Let your wrist extend over the edge of the surface.
3. Loosely holding a __________ weight or a piece of rubber exercise band or tubing, slowly curl your left / right hand up toward your forearm.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Ulnar deviators

1. Stand with a __________ weight in your left / right hand. Or, sit holding onto a rubber exercise band or tubing with your other arm supported on a table or other surface.
2. Move your left / right wrist so your pinkie travels toward your forearm and your thumb moves away from your forearm.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Radial deviators

1. Stand with a __________ weight in your left / right hand. Or, sit holding onto a rubber exercise band or tubing with your arm supported on a table or other surface.
2. Raise your left / right hand upward in front of you so your thumb travels toward your forearm, or pull up on the rubber tubing.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise I: Forearm rotation, supination

1. Sit with your left / right forearm supported on a table, keeping your elbow below shoulder height.
2. Rest your left / right hand over the edge of the table with your palm facing down.
3. Gently hold a hammer.
4. Without moving your elbow, slowly turn (rotate) your forearm to turn your palm and hand upward to a “thumbs-up” position.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise J: Forearm rotation, pronation

1. Sit with your left / right forearm supported on a table, keeping your elbow below shoulder height.
2. Rest your left / right hand over the edge with your palm facing up.
3. Gently hold a hammer.
4. Without moving your elbow, slowly turn (rotate) your forearm to turn your palm and hand upward to a “thumbs-up” position.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.