Ulnar Collateral Ligament Injury Clinical Presentation

Updated: Dec 22, 2021
  • Author: Robert F Kacprowicz, MD, FAAEM; Chief Editor: Sherwin SW Ho, MD  more...
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Medial elbow pain is the most common symptom in athletes who throw. Pain may be especially prominent during the acceleration phase of the overhead throw.

Pain is often chronic or recurrent, and it may lead to a slow erosion of the patient's throwing ability. Athletes may report having had similar pain in previous seasons of throwing.

Rest generally helps to relieve the pain.

Occasionally, during a single throw, athletes may experience acute pain over the medial elbow, sometimes associated with a popping sensation, that causes them to immediately stop throwing.


Physical Examination

Medial elbow tenderness and swelling are the most notable findings. Tenderness is commonly found approximately 2 cm distal to the medial epicondyle. UCL tenderness may occasionally be difficult to differentiate from flexor pronator tendinitis, but the pain of flexor pronator tendinitis is aggravated by resisting forearm pronation.

Loss of elbow range of motion (ROM) is occasionally observed.

With acute rupture, ecchymosis may be observed over the medial elbow.

Pain may be reproduced when the patient makes a clenched fist.

Valgus stress with the elbow in 25° of flexion (elbow abduction stress test) reproduces pain and may cause joint opening. The affected side should be compared with the contralateral elbow as a reference for baseline laxity.

Some throwing athletes have a baseline asymmetry; therefore, preseason documentation of baseline elbow laxity in elite athletes, especially pitchers, may be helpful for comparison if an injury occurs during the season.