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UCL Injuries

Publicly referred to Tommy John Surgery, UCL reconstruction is performed for athletes or individuals who have an unstable or torn UCL, or ulnar collateral ligament. This elbow injury is commonly seen in athletes, more specifically baseball pitchers, who have frequent and repetitive overhand throws, placing extremely high stresses on the elbow. An unstable or torn UCL develops gradually over time in athletes that don’t have adequate time to let the body heal and rest.


The ulnar collateral ligament (UCL) is the most commonly injured ligament in pitchers and throwers. In the elbow, the UCL runs on the inside of the elbow, which helps connect and secure your upper arm bone (humerus) with the ulna (forearm). This is one of two ligaments that help maintain the stability of the elbow.

When an injury occurs, the UCL may tear or sprain due to the overuse and repetitive stress put on the ligament when throwing. If the UCL does not heal properly, it can lead to a loose or unstable elbow.


If you are a baseball pitcher or perform regular overhand throws without proper resting time, you may be at risk of a UCL injury. Symptoms of a UCL injury may include:

  • Discomfort or pain during or after throwing
  • Numbness or tingling sensation in the hand
  • Popping noise heard when throwing


In most cases of UCL injury, Dr. Hackett recommends Tommy John Surgery for athletes who want the quickest recovery possible. There are some non-surgical methods for treating UCL injury, however it may take longer and may not be as effective as surgery, especially for current athletes. In any case, Dr. Hackett will evaluate your current condition and lifestyle and determine the best treatment course for a positive and efficient recovery.

Non-Surgical Treatments

In non-surgical methods, periods of rest are recommended after the injury. Then additional treatment options may include:

  • Physical Therapy – A rehabilitation program specifically designed by your physical therapist focuses on exercises that restore the strength and flexibility of the elbow. This will provide a gradual return to throwing once properly trained.
  • Change of Lifestyle – Although this may be undesirable for some individuals (like high-level athletes), a change of position or even change of sport can eliminate the high stresses on the elbow, which provides long-lasting relief.
  • Medications – Anti-inflammatory medications like ibuprofen and naproxen can help decrease swelling and reduce pain. This may be provided in prescription-strength form instead of just over-the-counter.

Surgical Treatment

If symptoms persist after non-surgical methods, or if the athlete desires to continue throwing, surgical treatment may be necessary to restore full function to the UCL and elbow. The most common procedure performed on athletes is called UCL reconstruction, more commonly known as Tommy John Surgery. Tommy John Surgery is named after the former major league Los Angeles Dodges’ pitcher who had the first successful surgery in 1974. Now it is a very common procedure performed for athletes so they can continue to compete in various sports.

UCL Reconstruction / “Tommy John Surgery” – Ligament tears are unable to sutured or stitched together. To surgically repair the torn UCL and restore elbow stability, the ligament is reconstructed from a tissue graft. During Tommy John Surgery, Dr. Hackett will remove the UCL and replace it with a tissue graft that acts as a scaffolding for a new ligament to grow. The ligament is reconstructed and woven in a figure-eight pattern through the ulna and humerus bones, which is then secured with sutures or screws. In most cases, the tissue graft is derived from one of the patient’s own tendons.

After this procedure, it may take 6 to 9 months or longer for athletes to return to competitive throwing, even with the necessary rehabilitation program.

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