Does an athlete with a partial UCL injury of the elbow need Tommy John surgery? Can you make it worse if you avoid surgery? I address these questions in my latest Ask Dr. Geier column.

Rob Knowlton in Santa Fe, New Mexico asks:
I have a tear of my MCL in my elbow. The surgeon has suggested reconstruction. If it is only a grade 2 tear and I don’t do the surgery now, can I hurt it any worse than it already is?

The ulnar collateral ligament (UCL) is the main stabilizer of the medial side of the elbow. It helps resist the valgus stress on the inside of the elbow that results from the throwing motion.

What is a UCL injury of the elbow?

Usually UCL injuries develop over time. The ligament gradually frays with pitching over the course of months or years. Eventually the UCL can fail, causing a complete or partial ligament tear.

Most throwing athletes that intend to continue competing choose to undergo UCL reconstruction (Tommy John surgery) to make a new ligament and restore stability of the elbow. The treatments for partial UCL injuries are not as straightforward.

Does a UCL injury need Tommy John surgery?

If enough of the UCL is torn that an athlete continues to have symptoms with throwing, surgery is often still necessary. Some athletes with partial tears might be able to return to sports with rest for up to six weeks and physical therapy. Some athletes have improved with platelet-rich plasma (PRP) injections.

Of course, we have seen many Major League Baseball pitchers suffer partial UCL tears of the elbow. They try a course of nonoperative treatment that often fails to help them return to pitching, so they undergo surgery.

Also read:
Tommy John surgery offers pitchers long-term success
What is causing the spike in Tommy John injuries?
The misperceptions of Tommy John surgery

That risk applies to any throwing or overhead athlete with a partial UCL injury. The partial tear could become a complete tear, or it can simply fail to improve enough to allow the athlete to return to sports.

Baseball pitcher throwing the ball off mound

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