A radial collateral ligament tear of the elbow is a relatively uncommon but significant injury, particularly in racquet-sports players and weightlifters. The radial collateral ligament is crucial in stabilising the outer elbow. When it’s torn, elbow stability is compromised, leading to pain and weakness. So how do you know you have a radial collateral ligament sprain of the elbow, and what can you do about it?
What is the radial collateral ligament?
The radial collateral ligament consists of four strong ligaments that surround the outside of the elbow. More than one of these usually has to tear before instability occurs. The large extensor tendon of the elbow — the tendon involved in tennis elbow — sits directly above these ligaments, which is why the two conditions are so closely linked.
Causes of a radial collateral ligament tear
A radial collateral ligament sprain or tear can result from an acute injury, repetitive stress, or a previous elbow injury.
One of the commonest causes is a fall onto an outstretched hand, which places excessive force on the outer elbow and overstretches the ligament. An elbow dislocation is a more severe example of an acute injury. Repetitive stress from sports such as tennis, baseball, and weightlifting can also damage the ligament through excessive load on the outer elbow.
Another important cause is repeated cortisone injections for tennis elbow. Because the ligament lies directly beneath the tennis elbow tendon, inaccurate cortisone injections can weaken it and lead to tearing, which is one reason we perform these injections under ultrasound guidance.
Symptoms of a radial collateral ligament tear
People with a radial collateral ligament tear of the elbow typically experience:
- Outer elbow pain that worsens with activity, gripping, or lifting
- Lateral elbow instability or giving way with certain movements, such as pushing off
- Clicking or popping with elbow movements
- A recent history of tennis elbow, with or without cortisone injections
How is an RCL tear elbow diagnosed?
Your sports doctor examines the elbow. There’s often tenderness over the outside of the elbow, close to the tennis elbow tendon — and because tennis elbow frequently coexists, the two can be hard to tell apart. We commonly use a stress test, applying inward pressure to reveal increased movement. The chair push-up test also helps: pain or instability on pushing up from a chair using the arms suggests lateral instability, as does pain or clunking during a push-up with the forearm rotated outwards.
Imaging usually confirms the diagnosis. MRI is the gold standard for ligament tears, showing the ligament’s integrity and any associated soft-tissue or cartilage damage. Ultrasound can also assess the ligament structure.
After trauma, it’s essential to exclude other injuries, such as a radial head fracture.
Treatment of a radial collateral ligament sprain or tear
Treatment depends on the severity of the injury.
For radial collateral ligament sprains, conservative treatment is often effective. Rest from aggravating sports is essential. Immobilisation with a hinged elbow brace may be used for 2–4 weeks to stabilise the elbow and allow healing. Physiotherapy is central to recovery — strengthening the forearm and wrist muscles to support the elbow and compensate for any ligament insufficiency. In some cases, platelet-rich plasma (PRP) can help ligament healing.
We recommend surgery for complete tears or chronic instability. If the ligament is torn but still in good condition, it can be repaired and reattached to its original site. Where it’s severely damaged, a graft restores stability. Surgical results are generally promising, with around 75% success, though a minority experience ongoing instability.
Frequently asked questions about an RCL tear elbow
Is there a link between persistent tennis elbow and a radial collateral ligament tear?
Yes. Tennis elbow (lateral epicondylitis) causes persistent outer elbow pain, and in chronic cases, the radial collateral ligament complex may also be torn, leading to ongoing pain and instability. Repeated cortisone injections can increase the risk of ligament damage, which is why a persistent “tennis elbow” that isn’t settling is worth reassessing.
Is a radial collateral ligament tear the same as tennis elbow?
No. Tennis elbow is a problem of the extensor tendon; a radial collateral ligament tear is a problem of the ligament beneath it. But they sit right on top of each other, often coexist, and cause pain in the same spot — so they’re easily confused, and a careful assessment (with MRI or ultrasound) tells them apart.
How long does a radial collateral ligament tear take to heal?
A sprain or partial tear often settles over several weeks with a brace and rehabilitation, though a full recovery can take longer. Complete tears or ongoing instability may need surgery, followed by a more prolonged rehabilitation.
Can you avoid surgery for a radial collateral ligament tear?
Often, yes — sprains and many partial tears respond to rest, a hinged brace, physiotherapy, and sometimes PRP. Surgery is reserved for complete tears or chronic instability that hasn’t responded to conservative treatment.
Can cortisone injections cause a radial collateral ligament tear?
They can contribute. Because the ligament lies directly under the tennis elbow tendon, repeated or inaccurate cortisone injections can weaken it and lead to tearing. Ultrasound-guided injections reduce this risk by accurately placing the cortisone.
What are the other causes of clicking or popping in the elbow?
Other causes include damaged elbow cartilage, loose bodies, triceps snapping syndrome, ulnar nerve dislocation, OCD of the elbow, and elbow plica syndrome. See our guide on why your elbow pops, and see a doctor for persistent elbow pain with clicking or popping.
Final word from Sport Doctor London about a radial collateral ligament tear of the elbow
A radial collateral ligament tear of the elbow is a significant but often overlooked injury, particularly in people who perform repetitive upper-limb activities or have persistent tennis elbow. Early recognition and appropriate management are key to preventing long-term instability. Many partial tears respond well to conservative treatment, while severe cases may need surgery.
If you have persistent outer elbow pain or instability, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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