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Elbow Instability, Ulnar Collateral Ligament Tear, and UCL Reconstruction
Ulnar Collateral Ligament (UCL) tears of the elbow are common cause of medial elbow pain and disability in overhead throwers. This is usually baseball players, but they also occur in football players, tennis players, and any athlete after a fall on an outstretched arm. They are also known as medial collateral tearMedial Collateral Ligament (MCL) tears of the elbow. They may occur suddenly with a fall or with a single pitch, or they may come on gradually after months or years of throwing. The most common symptom is pain on the medial, inside portion of the elbow.

Throwers or other athletes usually have difficulty competing at their usual level and will describe a decrease in their speed or accuracy. The function of the UCL is to stabilize the two main bones at the elbow, the ulna and humerus, as you throw an object or as you try to lift or push anything. 

When the ligament is torn, the bones and the muscles around the elbow help to provide stability, but sometimes this is not enough support.

Diagnosis of UCL tears can be made with a detailed history of your symptoms and a physical exam focused on your elbow. Valgus stress X-rays during that same visit can demonstrate laxity of the UCL. A MRI with intra-articular gadolinium is frequently used to confirm the diagnosis by noninvasively looking at the UCL to find partial or complete tears of the ligament.

The vast majority of partial and complete tears of the UCL can be treated nonoperatively. Initial treatment includes bracing with a hinged elbow brace and an aggressive physical therapy program that works on the entire kinetic chain, which starts with the body’s core muscles, extends through the shoulder blade and shoulder joint, and then works across the muscles of the elbow joint, and finally to the forearm and hand. 

Corrections of throwing technique are made at this same time. Bracing and therapy, along with a brief period of rest from throwing or sports, will frequently allow a complete return to sports and all activities.

The purpose of this surgery is to restore stability to your elbow so that you can return to full activities and throwing. Your sports medicine elbow surgeon will recreate a new ligament to replace the torn UCL. UCL reconstruction is also known as Tommy John surgery, named after the first professional pitcher who underwent this surgery and made a triumphant return to pitching. 

During UCL reconstruction surgery, a tendon is used to recreate or replace your torn UCL. That tendon is either from an organ donor, known as an allograft, or your surgeon can use an extra tendon from your forearm or thigh, known as an autograft. Both graft options have benefits and risks which your surgeon will discuss with you.

This is a day surgery procedure which takes place at St. Luke's Episcopal Hospital, located in the Texas Medical. You will be seen by an anesthesiologist prior to surgery, who will discuss the option of putting another kind of injection in your arm so that your whole arm goes to sleep prior to the surgery and stays asleep for 12 to 24 hours afterwards. Additionally, you will go to sleep with general anesthesia for the entirety of the surgery. 

The surgery takes less than one hour. When you wake up, you will have a sling and a splint stabilizing your elbow. You will stay in the recovery room until your pain is controlled and you are ready to leave for home.

Recovery from a UCL reconstruction is highly dependent upon a focused, sport specific physical therapy program. Initially, you will work on getting the motion back in your elbow. In the 6 to 12 months following the surgery, you will go forward with a therapy program which will start by strengthening the core muscles of your trunk, and then work on your shoulder and elbow strength. 

Proper throwing mechanics will be emphasized. Studies have shown that high level throwers and baseball pitchers can return to elite level play after they recover from UCL reconstruction.