Request an AppointmentCall 469-850-0680

The ulnar collateral ligament (UCL) is the main ligament on the inner side of the elbow. It holds the elbow stable against the huge “valgus” forces of throwing. Repeated throwing can stretch or tear it, which is why UCL injuries are most common in baseball pitchers, though they also occur in javelin throwers, volleyball players, gymnasts and after elbow dislocations.1 Reconstruction of the ligament is widely known as Tommy John surgery. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, offers the full range of UCL treatment, from rest and rehabilitation to PRP, repair and reconstruction.

On this page:Symptoms · Diagnosis · Non-surgical care · Repair · Reconstruction · Prevention · FAQs · Research
At a glance

  • Throwers typically notice inner elbow pain and a loss of velocity or control
  • Partial tears are usually treated first with rest, rehabilitation and a gradual throwing program, sometimes with PRP
  • UCL repair with an internal brace can return selected athletes to throwing faster than reconstruction
  • Tommy John reconstruction remains the standard for complete or worn-out ligaments, with most athletes returning to their previous level
  • Overuse and high pitch counts are major risk factors

Symptoms

  • Pain on the inner side of the elbow during or after throwing, especially in the late cocking and early acceleration phases
  • Loss of throwing velocity, command or control1
  • A sudden pop with a single throw (in an acute tear) or gradually worsening pain (with attritional damage)
  • Numbness or tingling in the ring and little fingers, because the ulnar nerve lies right next to the ligament1

Diagnosis

Dr. Dold examines the elbow for tenderness over the ligament and pain or opening with stress tests that recreate the throwing load. He also checks the ulnar nerve and the flexor-pronator tendons, since golfer’s elbow can cause similar pain. MRI (sometimes with contrast) shows whether the tear is partial or complete and whether it is at the upper (humeral) or lower (ulnar) attachment. Stress ultrasound can also show how much the joint opens.

Treatment without surgery

Partial tears are usually treated first without surgery:1

  • Rest from throwing, typically for several weeks
  • Physical therapy focusing on the flexor-pronator muscles (which help protect the ligament), the shoulder, core and lower body
  • A gradual interval throwing program once symptoms settle
  • PRP injection in selected partial tears

A 2023 meta-analysis of 365 athletes treated without surgery found that about 80% returned to sport. Lower-grade tears did very well, and tears at the upper (humeral) end returned far more often than tears at the lower (ulnar) end (about 90% vs 41%). In that analysis, return-to-sport rates were not significantly different with or without PRP.2 In a small series of baseball players whose partial or complete tears had not improved with rest, 26 of 30 returned to their prior level within 6 months after ultrasound-guided needling and PRP.3 Results vary: in an older study of throwers treated with at least 3 months of rest and rehabilitation, 42% returned to their previous level.4 Dr. Dold has published a systematic review of PRP5 and will discuss whether it makes sense for your injury.

UCL repair with internal brace

For selected athletes whose ligament has pulled off one end of the bone but otherwise has good-quality tissue, Dr. Dold can repair the ligament back to bone and reinforce it with a collagen-coated suture tape (an “internal brace”). In the first large series of 111 overhead athletes, 92% of those who wanted to return to the same or higher level did so, at an average of 6.7 months.6 Whether repair or reconstruction is the right choice is sometimes decided at the time of surgery, based on the condition of the ligament.6

UCL reconstruction (Tommy John surgery)

When the ligament is completely torn or worn out, it is reconstructed using a tendon graft, most often the palmaris longus tendon from the forearm, passed through tunnels in the bone to recreate the ligament.1 The ulnar nerve is protected and moved if needed.

  • In 743 athletes followed for at least 2 years, 83% returned to their previous level of competition or higher; average time to full competition was 11.6 months.7
  • Among Major League Baseball pitchers, 83% returned to pitch in the major leagues, at an average of about 20 months, and 97% returned to pitching at the major or minor league level.8
  • In high school players, 74% returned to the same or higher level.9

Complications occurred in about 20% of patients in the largest series, most of them minor (16% minor, 4% major).7

Recovery

Rehabilitation starts with protecting the repair and restoring motion, then progresses to strengthening of the forearm, shoulder, core and legs, and finally a structured interval throwing program. Most athletes need about 12 to 18 months to return fully after reconstruction,1 compared with a shorter timeline after repair in suitable cases.6

Prevention for young throwers

In a study of high school players who needed UCL reconstruction, 85% reported at least one form of overuse, such as year-round throwing or high pitch counts, and many had thrown breaking pitches before age 14.9 Following pitch-count and rest guidelines, avoiding year-round throwing, and taking pain or loss of velocity seriously are key ways to protect a young thrower’s elbow.

What the research shows

Here is what larger reviews add about UCL injuries in throwers.

Partial tears

Many partial tears can be treated without surgery; on average about 3 in 4 overhead athletes returned to play in pooled studies. Results after PRP injections vary widely between studies, and programs with at least 12 weeks of rehabilitation reported better outcomes.

Reconstruction

Across more than 1,100 baseball players followed for about 6 years, 95% returned to play after Tommy John surgery and 85% to their previous level. Recovery is long, often a year or more, and some pitchers show a decline in in-game performance. Return rates after revision surgery are lower. Modern techniques, including the docking method and approaches that limit handling of the ulnar nerve, have reduced complications.

Repair

UCL repair with suture-tape augmentation is increasingly used for selected tears and may allow a faster return, but long-term results, especially in elite athletes, are still limited.

Prevention

A randomized trial found a prevention program reduced throwing injuries in youth baseball. Weighted-ball programs increased velocity but also increased injuries in one trial, and early single-sport specialization is linked to more arm injuries.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Does a UCL tear always need Tommy John surgery?

No. Many partial tears improve with rest, rehabilitation and a gradual throwing program, sometimes with PRP. In a 2023 meta-analysis, about 80% of athletes treated without surgery returned to sport.2

What is the difference between UCL repair and reconstruction?

Repair reattaches your own ligament to bone and reinforces it with suture tape; reconstruction replaces the ligament with a tendon graft. Repair is only suitable for selected tears with good tissue but can allow a faster return.6

How long is recovery after Tommy John surgery?

Most athletes need about 12 to 18 months to return fully to competitive throwing.1,7

Will I throw harder after Tommy John surgery?

Tommy John surgery is not a way to increase velocity. Its goal is to restore a stable elbow so you can return to your previous level.

Does PRP help a UCL tear?

PRP is used for some partial tears and early reports are encouraging, but a 2023 meta-analysis found no significant difference in return to sport with or without PRP.2,3

How can young pitchers prevent UCL injuries?

Avoiding overuse is key: follow pitch-count and rest guidelines, avoid year-round throwing and stop throwing when the elbow hurts.9

Hurt playing sports? See how Dr. Dold, a sports medicine doctor in Frisco, treats athletes of every age and level.

Research cited on this page

  1. Chalmers PN, Bowman E, Erickson BJ, et al. Elbow Ulnar Collateral Ligament Tears in 2023: Evaluation and Management. Instr Course Lect. 2024;73:725-736. PubMed
  2. Gopinatth V, Batra AK, Khan ZA, et al. Return to Sport After Nonoperative Management of Elbow Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis. Am J Sports Med. 2023;51(14):3858-3869. PubMed
  3. Kato Y, Yamada S, Chavez J. Can platelet-rich plasma therapy save patients with ulnar collateral ligament tears from surgery?. Regen Ther. 2019;10:123-126. PubMed
  4. Rettig AC, Sherrill C, Snead DS, et al. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;29(1):15-17. PubMed
  5. Dold AP, Zywiel MG, Taylor DW, Dwyer T, Theodoropoulos J. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med. 2014;24(1):31-43. PubMed
  6. Dugas JR, Looze CA, Capogna B, et al. Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes. Am J Sports Med. 2019;47(5):1096-1102. PubMed
  7. Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426-2434. PubMed
  8. Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536-543. PubMed
  9. Petty DH, Andrews JR, Fleisig GS, et al. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158-1164. PubMed
  10. Cascia N, Picha K, Hettrich CM, et al. Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review. Sports Health. 2019;11(4):367-374. PubMed
    Non-surgical treatment of partial UCL tears returned about 78% of overhead athletes to play on average, using rest, strengthening and a throwing program.
  11. Fucaloro SP, Kang AS, Bragg JT, et al. Return to Sport After Ulnar Collateral Ligament Tears Treated with Platelet-Rich Plasma Injections is Influenced by Length of Rehabilitation and Leukocyte Content of Injections: A Systematic Review. Arthroscopy. 2025;41(2):343-356. PubMed
    After PRP injection for UCL tears, return-to-sport rates ranged widely (46% to 100%), and studies with at least 12 weeks of rehabilitation reported better results.
  12. Carr JB, Camp CL, Dines JS. Elbow Ulnar Collateral Ligament Injuries: Indications, Management, and Outcomes. Arthroscopy. 2020;36(5):1221-1222. PubMed
    A review reported 80–90% return to play after UCL reconstruction and noted that long-term results of suture-tape repair are still limited, especially in elite athletes.
  13. Moore AR, Fleisig GS, Dugas JR. Ulnar Collateral Ligament Repair. Orthop Clin North Am. 2019;50(3):383-389. PubMed
    A review described the spectrum of UCL injuries, from partial tears to end avulsions, and the surgical options for each.
  14. Sholtis C, Loughran GJ, Kwon N, et al. Ulnar Collateral Ligament Repair. Instr Course Lect. 2025;74:51-60. PubMed
    A 2025 review discussed the rising rate of UCL surgery and the expanding role of repair alongside reconstruction.
  15. Davey MS, Hurley ET, Gaafar M, et al. Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. J ISAKOS. 2021;6(5):290-294. PubMed
    Across 1,104 baseball players followed for about 6 years, 95% returned to play after reconstruction and 85% to their previous level.
  16. Hadley CJ, Edelman D, Arevalo A, et al. Ulnar Collateral Ligament Reconstruction in Adolescents: A Systematic Review. Am J Sports Med. 2021;49(5):1355-1362. PubMed
    In adolescents, about 84% returned to the same or a higher level after UCL reconstruction.
  17. Coughlin RP, Gohal C, Horner NS, et al. Return to Play and In-Game Performance Statistics Among Pitchers After Ulnar Collateral Ligament Reconstruction of the Elbow: A Systematic Review. Am J Sports Med. 2019;47(8):2003-2010. PubMed
    Most pitchers returned to pitching after reconstruction, but recovery was long and many studies showed some decline in in-game performance.
  18. Hones KM, Kamarajugadda S, Buchanan TR, et al. Variable Return to Play and Sport Performance After Elbow Ulnar Collateral Ligament Reconstruction in Baseball Players: A Systematic Review. Arthroscopy. 2024;40(7):1997-2006.e1. PubMed
    Return to play after primary reconstruction took roughly 11 to 20 months, and return to the same level after revision surgery was as low as 42%.
  19. Watson JN, McQueen P, Hutchinson MR. A systematic review of ulnar collateral ligament reconstruction techniques. Am J Sports Med. 2014;42(10):2510-6. PubMed
    The docking technique had a higher return-to-play rate and fewer complications than the original Jobe techniques.
  20. Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008;36(6):1193-205. PubMed
    Excellent results were reported in 83% after reconstruction; ulnar nerve symptoms were the most common complication, and muscle-splitting approaches reduced complications.
  21. Somerson JS, Petersen JP, Neradilek MB, et al. Complications and Outcomes After Medial Ulnar Collateral Ligament Reconstruction: A Meta-Regression and Systematic Review. JBJS Rev. 2018;6(5):e4. PubMed
    Studies using the docking technique and with lower rates of ulnar nerve symptoms reported more excellent results.
  22. Hones KM, Simcox T, Hao KA, et al. Graft choice and techniques used in elbow ulnar collateral ligament reconstruction over the last 20 years: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2024;33(5):1185-1199. PubMed
    A meta-analysis found palmaris longus autograft and the modified Jobe figure-of-eight configuration were most commonly used.
  23. Berk AN, Rao AJ, Ahmad CS, et al. Inconsistencies in reporting risk factors for ulnar collateral ligament reconstruction failure: a systematic review. J Shoulder Elbow Surg. 2023;32(7):1534-1544. PubMed
    Age, level of play, postoperative workload and years at the professional level were the most commonly reported risk factors for reconstruction failure.
  24. Sakata J, Nakamura E, Suzuki T, et al. Throwing Injuries in Youth Baseball Players: Can a Prevention Program Help? A Randomized Controlled Trial. Am J Sports Med. 2019;47(11):2709-2716. PubMed
    In a randomized trial, a prevention program reduced shoulder and elbow throwing injuries in youth baseball players.
  25. Reinold MM, Macrina LC, Fleisig GS, et al. Effect of a 6-Week Weighted Baseball Throwing Program on Pitch Velocity, Pitching Arm Biomechanics, Passive Range of Motion, and Injury Rates. Sports Health. 2018;10(4):327-333. PubMed
    A 6-week weighted-ball program increased pitch velocity but also increased the injury rate.
  26. Zaremski JL, Zeppieri G, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train. 2019;54(10):1030-1039. PubMed
    A review linked early sport specialization in young throwers to more dominant-arm shoulder and elbow injuries.
Ready to get it checked? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. We see patients from Frisco, Plano, McKinney, Prosper, Little Elm, The Colony, Allen, Dallas and across North Texas. Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.