Tommy John surgery (UCL reconstruction)

Elbow pain and instability can be frustrating, especially when your daily activities, work or athletic performance depend on a strong, reliable throwing arm. UCL reconstruction, often called Tommy John surgery, treats injuries to the ulnar collateral ligament and can help restore stability and function in the elbow. Novant Health orthopedic specialists provide expert evaluation, advanced treatment and personalized rehabilitation to help you return to activity with confidence.

Find a specialist

Find a location

What is UCL reconstruction?

The ulnar collateral ligament, or UCL, is a strong band of tissue on the inner side of the elbow. It connects the upper arm bone to the forearm bone and helps stabilize the elbow during overhead and throwing motions. Every time you throw, serve or lift overhead, stress travels through this ligament to keep the elbow from bending too far sideways.

Over time, or after a sudden injury, the UCL can stretch or tear. When this happens, UCL reconstruction, commonly known as Tommy John surgery, may be recommended. During the procedure, a tendon graft, often taken from your forearm, hamstring or a donor, replaces the damaged ligament. The surgeon secures the graft through small tunnels in the arm bones to create a new, stable ligament over time. This surgery is typically considered when the UCL is completely torn or when nonsurgical care hasn't relieved symptoms.

Common reasons for UCL reconstruction

UCL injuries most often develop from repetitive strain rather than a single injury. You may need evaluation for a UCL injury if you notice:

Pain or soreness on the inside of the elbow
Swelling or tenderness around the joint
A popping sensation at the time of injury
Decreased throwing velocity, strength or accuracy
A feeling of looseness or instability in the elbow
Tingling or numbness in the forearm or hand

Common contributing factors include repetitive overhead throwing or pitching, sudden increases in training intensity, poor throwing mechanics, inadequate rest between practices or games and previous elbow injuries. Baseball and softball players, tennis players and other throwing athletes face higher risk, but anyone whose job or hobbies involve frequent overhead arm use can develop a UCL injury.

Treatment options (surgical & nonsurgical)

Treatment depends on the severity of the UCL injury and your activity goals. Options include:

Rest from throwing or overhead activities to allow the ligament to heal
Ice and anti-inflammatory medications to reduce pain and swelling
Bracing to support and protect the elbow during daily activities
Physical therapy focused on flexibility, strength and proper throwing mechanics
Biologic treatments, such as platelet-rich plasma (PRP), for some patients depending on injury severity and goals
UCL reconstruction (Tommy John surgery) for complete tears or when nonsurgical care doesn't relieve symptoms

Many partial UCL tears and mild injuries can be managed without surgery. When surgery is needed, many procedures are performed using minimally invasive techniques to support recovery.

Recovery and rehabilitation

Recovery from UCL reconstruction requires patience and a structured rehabilitation plan:

Weeks 0 to 6: Protection in a brace with gentle motion
Weeks 6 to 12: Progressive strengthening and flexibility
Months 3 to 6: Sport-specific training and controlled throwing
Months 9 to 12: Return to full athletic activity

Rehabilitation specialists work closely with you throughout recovery to help restore strength, motion and confidence while reducing the risk of reinjury. Recovery timelines can vary depending on your injury and progress, and your care team will adjust your plan as needed.

Risks and considerations

As with any surgery, UCL reconstruction carries some risks, including infection, stiffness, nerve irritation or graft failure. Your care team will review these risks with you in detail, answer your questions and help you understand what to expect before, during and after surgery. Every treatment plan is tailored to your specific injury and goals, and your surgeon will help you weigh the benefits and risks of surgical versus nonsurgical care.

Conditions we treat

Our expert team delivers expert care for a wide range of sports and activity-related injuries and conditions.

View conditions

Why treatment is important

Untreated UCL injuries can affect your comfort, strength and ability to return to the activities you enjoy. Seeking evaluation and treatment early can help protect your elbow and support a smoother path toward recovery. Our team is here to guide you through every step, from diagnosis to full return to activity.