I finally found out why I’ve been having so much trouble with my elbow. I have been having pain anytime I extend my elbow, push a door open, or try to throw the ball for my dogs. Turns out I have a torn ulnar collateral ligament. I guess it’s something they see with javelin throwers and pitchers. But I did take a fall last winter on the ice and that may have done it for me. What’s the best way to treat this problem this late in the game?

The UCL is also known as the medial collateral ligament. It is located on the medial (the side of the elbow that’s next to the body) side of the elbow. The ulnar collateral ligament is a thick band of ligamentous tissue that forms a triangular shape along the medial elbow. It has an anterior bundle, posterior bundle, and a thinner, transverse ligament. It helps keep the elbow joint stable and helps prevent dislocation during trauma or injury.

The ulnar collateral ligament (UCL) can become stretched, frayed or torn through the stress of repetitive throwing motions. Professional pitchers have been the athletes treated most often for this problem. Javelin throwers, football players, as well as athletes involved in racquet sports, ice hockey, wrestlers, and water polo players have also been reported to injure the UCL. But as you have found out, a fall on an outstretched arm can also lead to UCL rupture.

If it does not heal correctly the elbow can be too loose or unstable. Painful symptoms such as you describe can develop. If there are loose fragments or uneven joint surfaces, you may also notice popping, catching, or grinding. Sometimes swelling can be seen along the inside of the elbow. And some people notice a slight loss of elbow motion. Closing the hand and clenching the fist can reproduce the painful symptoms.

Sometimes an injury to the UCL can be treated conservatively (without surgery). The nonoperative approach can work well for patients who have a partially torn but not completely ruptured ligament.

The conservative approach may also be recommended for patients who are not athletes and therefore not involved in activities that require overhead throwing. Being able to throw the ball for your dogs without pain may not be a sign that you need surgery. It’s possible the surgeon will recommend rest from aggravating activities like throwing and a rehab program with a physical therapist.

The therapist will evaluate your joint motion, alignment and posture, and strength. Depending on your symptoms and clinical picture, a program will be designed to meet your individual needs and goals. If you follow the program given to you, you can expect a gradual return of pain free motion and strength over a period of three to six months.