Sex Differences in Elbow Ulnar Collateral Ligament Injuries: A Retrospective Analysis


  • Mason F. Beaudry Baylor Scott & White, Southwest Sports Medicine & Orthopaedics
  • Anna G. Beaudry Baylor Univeristy
  • Monica M. Bennett Baylor Scott & White Research Institute
  • Bradley D. Gilliam Baylor Scott & White, Southwest Sports Medicine & Orthopaedics
  • David E. Haynes Baylor Scott & White, Southwest Sports Medicine & Orthopaedics



UCL, Elbow Injury, Female Athletes


BACKGROUND: The incidence of UCL injuries has increased considerably and is well documented in male-focused literature. Although women are not immune to UCL injuries, limited work has explored potential sex-specific differences in UCL mechanism of injury, clinical presentation, care pathway, or return to play. The purpose of the present study was to evaluate patterns of elbow UCL injury in male and female athletes via MRI review.METHODS: Retrospective chart review of diagnosed elbow UCL injuries at a single sports medicine institution from January 2015- January 2022 was performed. Inclusion criteria were as follows: (1) patients 15-35 years of age, (2) diagnosis of an elbow UCL injury, (3) athlete, (4) MRI of elbow at the time of injury, (5) patient documentation records with demographic information. Male and female groups were compared for differences in injury patterns and the presence of concurrent injuries. A secondary analysis assessed demographic differences between the two cohorts. To determine if there were statistically significant differences between males and females, t-tests or Mann-Whitney U tests were used for numerical variables based on distribution, while chi-square or Fisher’s exact tests were used for categorical variables.

RESULTS: Of 1,068 patients diagnosed with a UCL injury during the study window, 168 patients met inclusion criteria (113 (67%) males and 55 (33%) females). The average age in both groups was 17.9 ± 2 years. No statistically significant differences were observed with regard to handedness, injury year, or injury month. When comparing injury-related clinical factors between male and female patients, statistically significant differences were discovered for injury onset, UCL grade, and tear location (all p<0.001). Males had a higher rate of bony edema (63% vs. 26%; p<0.001). No significant differences were found with other associated injuries.  

CONCLUSION: This present study demonstrates that sex-specific differences exist in UCL injury patterns – including onset of UCL injury, grade, and tear location. We also found that MRI findings, symptom duration, and management strategies differed between male and female athletes. Female athletes more commonly presented with chronic UCL injuries, many of which displayed no significant findings on MRI imaging. The results of this study suggest that sex-specific differences in UCL injury occurrence and presentation exist. Further research is needed to better inform the care and treatment of UCL injuries in both male and female athletes.


Aguinaldo AL, Chambers H. Correlation of throwing mechanics with elbow valgus load in adult baseball pitchers. Am J Sports Med. 2009;37(10):2043-2048. doi:10.1177/0363546509336721

Anz AW, Bushnell BD, Griffin LP, Noonan TJ, Torry MR, Hawkins RJ. Correlation of torque and elbow injury in professional baseball pitchers. Am J Sports Med. 2010;38(7):1368-1374. doi:10.1177/0363546510363402

Chalmers PN, Erickson BJ, Ball B, Romeo AA, Verma NN. Fastball Pitch Velocity Helps Predict Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Am J Sports Med. 2016;44(8):2130-2135. doi:10.1177/0363546516634305

Dines JS, Frank JB, Akerman M, Yocum LA. Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med. 2009;37(3):566-570. doi:10.1177/0363546508326712

Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;4(5):419-424. doi:10.1177/1941738112454828

Cain EL Jr, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426-2434. doi:10.1177/0363546510378100

Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536-543. doi:10.1177/0363546513510890

Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158-1164. doi:10.1177/0363546503262166

Gardner, E.C., Manzi, J., McElheny, K., Bedi, A. (2021). Ulnar Collateral Ligament Injury in Female Athletes. In: Dines, J.S., Camp, C.L., Altchek, D.W. (eds) Elbow Ulnar Collateral Ligament Injury. Springer, Cham.

Argo D, Trenhaile SW, Savoie FH 3rd, Field LD. Operative treatment of ulnar collateral ligament insufficiency of the elbow in female athletes. Am J Sports Med. 2006;34(3):431-437. doi:10.1177/0363546505281240

Hashemi J, Chandrashekar N, Mansouri H, Slauterbeck JR, Hardy DM. The human anterior cruciate ligament: sex differences in ultrastructure and correlation with biomechanical properties. J Orthop Res. 2008;26(7):945-950. doi:10.1002/jor.20621

Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943-2950. doi:10.1016/j.jbiomech.2005.10.031

Boden BP, Sheehan FT, Torg JS, Hewett TE. Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg. 2010;18(9):520-527. doi:10.5435/00124635-201009000-00003

Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42(6):394-412. doi:10.1136/bjsm.2008.048934

Berkson, MD, E. . (2022). Editorial Commentary: Moving on from studying only the ACL: The importance of sex differences in other orthopaedic injuries. Journal of Women’s Sports Medicine, 2(1), 27–29.

Lee H, Petrofsky JS, Laymon M, Yim J. A greater reduction of anterior cruciate ligament elasticity in women compared to men as a result of delayed onset muscle soreness. Tohoku J Exp Med. 2013;231(2):111-115. doi:10.1620/tjem.231.111

Lee H, Petrofsky JS, Daher N, Berk L, Laymon M, Khowailed IA. Anterior cruciate ligament elasticity and force for flexion during the menstrual cycle. Med Sci Monit. 2013;19:1080-1088. Published 2013 Nov 29. doi:10.12659/MSM.889393

Hewett TE, Zazulak BT, Myer GD. Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med. 2007;35(4):659-668. doi:10.1177/0363546506295699

Wojtys EM, Huston LJ, Boynton MD, Spindler KP, Lindenfeld TN. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002;30(2):182-188. doi:10.1177/03635465020300020601

Kodde IF, Rahusen FT, Eygendaal D. Long-term results after ulnar collateral ligament reconstruction of the elbow in European athletes with interference screw technique and triceps fascia autograft. J Shoulder Elbow Surg. 2012;21(12):1656-1663. doi:10.1016/j.jse.2012.07.010

Grumet RC, Friel NA, Cole BJ. Bony avulsion of the medial ulnar collateral ligament in a gymnast: a case report. J Shoulder Elbow Surg. 2010;19(7):e1-e6. doi:10.1016/j.jse.2010.04.007

Sampath SC, Sampath SC, Bredella MA. Magnetic resonance imaging of the elbow: a structured approach. Sports Health. 2013;5(1):34-49. doi:10.1177/1941738112467941

Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 2005;34(1):1-18. doi:10.1007/s00256-004-0854-y

Joyner PW, Bruce J, Hess R, Mates A, Mills FB 4th, Andrews JR. Magnetic resonance imaging-based classification for ulnar collateral ligament injuries of the elbow. J Shoulder Elbow Surg. 2016;25(10):1710-1716. doi:10.1016/j.jse.2016.05.006

Wilson FD, Andrews JR, Blackburn TA, McCluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med. 1983;11(2):83-88. doi:10.1177/036354658301100206

Miller CD, Savoie FH 3rd. Valgus Extension Injuries of the Elbow in the Throwing Athlete. J Am Acad Orthop Surg. 1994;2(5):261-269. doi:10.5435/00124635-199409000-00004

Dines JS, Camp CL, Altchek DW, eds. Elbow Ulnar Collateral Ligament Injury: A Guide to Diagnosis and Treatment. Manhattan, NY: Springer International Publishing; 2021

Weber CL, Chia M, Inbar O. Gender differences in anaerobic power of the arms and legs--a scaling issue. Med Sci Sports Exerc. 2006;38(1):129-137. doi:10.1249/01.mss.0000179902.31527.2c

Chu Y, Fleisig GS, Simpson KJ, Andrews JR. Biomechanical comparison between elite female and male baseball pitchers. J Appl Biomech. 2009;25(1):22-31. doi:10.1123/jab.25.1.22

Nicolette GW, Gravlee JR. Ulnar collateral ligament injuries of the elbow in female division I collegiate gymnasts: a report of five cases. Open Access J Sports Med. 2018;9:183-189. Published 2018 Sep 7. doi:10.2147/OAJSM.S159624

Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689-1694. doi:10.1177/0363546513487979

Jones KJ, Dines JS, Rebolledo BJ, et al. Operative management of ulnar collateral ligament insufficiency in adolescent athletes. Am J Sports Med. 2014;42(1):117-121. doi:10.1177/0363546513507695

Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67-83

Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158-1163.

Smith MV, Bernholt DL. Ulnar collateral ligament injury in the elbow: current trends for treatment. Annals of Joint. 2020:5(0).

Jang SH. Management of Ulnar Collateral Ligament Injuries in Overhead Athletes. Clin Shoulder Elb. 2019;22(4):235-240. Published 2019 Dec 1. doi:10.5397/cise.2019.22.4.235

Swindell HW, Trofa DP, Confino J, Sonnenfeld JJ, Alexander FJ, Ahmad CS. Performance in Collegiate-Level Baseball Players After Elbow Ulnar Collateral Ligament Reconstruction. Orthop J Sports Med. 2020;8(4):2325967120913013. Published 2020 Apr 17. doi:10.1177/2325967120913013

Swindell HW, Trofa DP, Alexander FJ, Sonnenfeld JJ, Saltzman BM, Ahmad CS. Nonsurgical Management of Ulnar Collateral Ligament Injuries. J Am Acad Orthop Surg Glob Res Rev. 2021;5(4):10.5435/JAAOSGlobal-D-20-00257. Published 2021 Apr 9. doi:10.5435/JAAOSGlobal-D-20-00257







How to Cite

Sex Differences in Elbow Ulnar Collateral Ligament Injuries: A Retrospective Analysis. (2023). Journal of Women’s Sports Medicine, 3(1), 14-24.

Similar Articles

1-10 of 34

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

1 2 3 4 > >>