UCL Injury (Thrower’s Elbow / Tommy John Injury)

What is a UCL Injury?

The ulnar collateral ligament (UCL) is on the inside of the elbow and provides stability, especially during throwing. UCL injuries range from minor sprains to full tears and are most common in baseball pitchers and overhead throwers.

Common Symptoms

• Pain along the inner elbow during throwing

• Loss of throwing velocity or accuracy

• Swelling or tenderness over the UCL

• A “popping” sensation at the time of injury (in severe tears)

Physical Therapist Diagnoses

A PT examines the elbow for tenderness and uses valgus stress testing to assess ligament stability. A moving valgus stress test is especially sensitive for throwers. Imaging (MRI) may be ordered for suspected high-grade tears.

Why it Happens

The UCL is stressed repeatedly in throwing athletes, especially pitchers. Poor mechanics, high pitch volume, or inadequate strength in supporting muscles can overload the ligament.

Why it Doesn’t Always Heal on Its Own

Ligaments have limited blood supply and heal slowly. Minor sprains may improve with rest, but significant injuries require structured rehab — and in severe cases, surgery.

Ideal Physical Therapy Treatment

Rehabilitation emphasizes pain management, restoring mobility, and building strength and stability for throwing. Dry needling may be used for secondary muscle tightness in the forearm or surrounding muscles, but the primary focus is on joint and ligament stability.

Key components include:

• Manual therapy and mobility work to maintain elbow and shoulder motion

• Strengthening of forearm, rotator cuff, and scapular stabilizers

• Throwing mechanics analysis and correction

• Progressive throwing programs to return to sport

• Dry needling for muscular tightness contributing to pain or compensation

Expected Outcomes

Many partial UCL injuries respond well to therapy and structured throwing programs. Full tears often require surgery (Tommy John procedure), but pre- and post-operative PT significantly improves outcomes.

Key Takeaway

A UCL injury doesn’t have to end a throwing career. With proper rehab and mechanics training, many athletes return to throwing at full strength.