What is the treatment for an ulnar collateral ligament (UCL) sprain?

Treatment of Ulnar Collateral Ligament Sprain

For UCL sprains, begin immediate functional rehabilitation with NSAIDs for pain control (maximum 14 days), avoid prolonged immobilization beyond 10 days, and implement a structured exercise program focusing on range of motion followed by strengthening and sport-specific throwing progression, reserving surgery only for complete tears or failed conservative management after 3-4 months. 1, 2, 3

Initial Management (First 10 Days)

• Use NSAIDs for short-term pain relief (less than 14 days) to control pain and swelling without significantly increasing adverse events 1
• If severe pain is present, consider brief immobilization with a semirigid brace for a maximum of 10 days, then transition immediately to functional treatment 1
• Avoid elastic bandages or compression wraps alone—semirigid supports are significantly more effective 1
• Do not rely on RICE protocol as a primary treatment, as it has no proven positive influence on pain, swelling, or function 1

Functional Rehabilitation Protocol

Begin supervised exercise therapy immediately after the initial pain control phase, following this specific progression: 1, 2, 3

Phase 1: Range of Motion (Weeks 1-2)

• Start with gentle elbow flexion-extension exercises and forearm pronation-supination movements 1
• Progress to full pain-free range of motion before advancing to strengthening 1

Phase 2: Strengthening (Weeks 2-6)

• Focus on kinetic chain strengthening including shoulder, scapular, and core musculature 2
• Implement proprioception exercises targeting coordination and neuromuscular control 1
• Use functional support (bracing) for 4-6 weeks during this rehabilitation period 1

Phase 3: Sport-Specific Training (Weeks 6-12)

• Initiate an interval throwing program with graduated intensity and volume 2, 3
• Most athletes with low- to medium-grade partial tears (Grade I or II) return to competitive throwing in 3-4 months 3
• Monitor patient-reported outcomes and adjust progression based on symptoms 2

Manual Mobilization

• Combine manual joint mobilization with exercise therapy for enhanced efficacy—mobilization alone provides only short-term benefits 1
• Joint mobilization can decrease pain and increase elbow dorsiflexion range of motion when integrated into comprehensive treatment 1

Platelet-Rich Plasma Considerations

• PRP injections may be considered for partial UCL tears in overhead athletes, though robust clinical data are currently lacking 3
• PRP was included in 71% of successful rehabilitation protocols in systematic review, but should not replace structured exercise therapy 2

Surgical Indications

Surgery is indicated for: 1, 3, 4

• Complete (Grade III) UCL tears 3
• Failed extensive conservative management after 3-4 months in partial tears 3
• Professional athletes requiring rapid return to play who have not responded to conservative treatment 1

Surgical outcomes: 3, 5

• UCL reconstruction (modified Jobe or docking technique) shows 80-90% return-to-play rates 3, 5
• Professional pitchers typically require 15-18 months to return to previous competition level 3
• UCL repair with suture tape augmentation is emerging but lacks long-term data in elite athletes 3

Critical Factors Affecting Treatment Decisions

Consider these specific factors when determining treatment approach: 2

• Age: Younger athletes (<20 years) with acute avulsion injuries may benefit from repair 5
• Grade of tear: Low-grade (I-II) partial tears have 42-100% return-to-play rates with conservative treatment (mean 78%) 2
• Level of competition: Professional athletes may require different timelines and surgical consideration 3
• Athlete's perceived well-being: Use patient-reported outcomes to guide progression 2

Common Pitfalls to Avoid

• Do not immobilize for extended periods—this correlates with worse functional outcomes and delayed return to sport 1
• Do not use NSAIDs beyond 14 days—prolonged use may delay natural healing as inflammation is necessary for tissue recovery 1
• Do not skip kinetic chain strengthening—focusing only on elbow strengthening ignores the biomechanical contributors to UCL stress 2
• Do not rush the throwing program—advancing too quickly increases risk of re-injury and conversion to surgical management 2, 3
• Re-examine at 3-5 days post-injury when pain and swelling have improved to accurately assess ligament damage severity 1

Return to Sport Criteria

• Implement supervised exercises focusing on proprioception, strength, coordination, and sport-specific function 1
• Use a graduated interval throwing program with specific pitch counts and rest intervals 2
• Monitor pitch velocity, days between outings, and overall workload as these are identified risk factors for UCL injury 3
• Ensure full pain-free range of motion and strength before progressing to competitive throwing 2