Medial ulnar collateral ligament injuries occur in athletes of all sports and levels and can be acute or chronic in nature. The rate of ulnar collateral ligament (UCL) repairs and reconstructions has increased as operative intervention has been shown to increase rates of return to play and return to same level of play in athletes. It is important to understand the anatomy and biomechanics of the UCL, as the UCL is integral to stabilizing the elbow against valgus stress, along with static and dynamic restraint of surrounding bony and soft tissue structures. A thorough history and physical exam should assess the mechanism of injury, the athlete’s current and aspirational level of play, and the stability of the elbow throughout range of motion and with provocative testing. Diagnostic imaging, including radiographs and MRI, confirms the grade of injury and guides management of the injury. Nonoperative and operative interventions should be reviewed in detail with patients to allow for educated decision-making and maximization of upper extremity function and return to sport. Partial injuries can be amenable to nonoperative management with a short period of immobilization followed by a dedicated rehabilitation protocol that focuses on range of motion and strengthening of the upper extremity. For higher-grade injuries or in throwing patients, operative management through repair or reconstruction of the UCL may be indicated. Each patient is evaluated and managed individually, keeping in mind the patient’s symptoms, rehabilitation progress, and functional goals following his or her injury.