Since the first description of an ulnar collateral ligament (UCL) tear at the elbow 60 years ago and the first description of surgical reconstruction 20 years ago, many advances have been made in management and surgery. UCL tears at the elbow remain a disease of the overhead athlete. Various imaging studies have been used in the diagnosis of UCL tears at the elbow; however, the physical examination and history continue to be the most important tools. This article describes the history and what has been learned as well as the approach to the treatment of UCL tears at the elbow.