ULNAR COLLATERAL LIGAMENT RECONSTRUCTION REHABILITATION PROTOCOL

Posted on: January 5th, 2014 by Chris Jones, MD No Comments

 

This protocol is designed to guide the recovery and rehabilitation following surgical reconstruction of the ulnar collateral ligament.  It is divided into 4 phases with the ultimate goal of regaining full function and strength of the operative extremity.  For full recovery it will require significant time for graft healing and incorporation as well as a dedicated program for development of strength and endurance.  Generally speaking it requires approximately 8 months for return to competitive throwing.

 

PHASE 1: Post Op Days 1 to 10.  Immediate Post Op Phase

 

Goals

  • Pain control
  • Limit soft tissue swelling
  • Wound healing
  • Begin Wrist and finger ROM

 

Exercises

  • Shoulder ROM and sub-maximal isometrics as tolerated
  • Wrist flexion/extension
  • Finger ROM
  • Grip ball exercises
  • Maintain splint and compressive wrap on elbow

 

Modalities

  • Cryotherapy

 

PHASE 2: Weeks 2-6. Early Range of Motion

 

Goals

  • Initiate Elbow assisted range of motion
  • Continue shoulder, wrist and elbow motion
  • Transition to hinged elbow brace

 

Brace

  • Allowing ROM 30-100 degrees for week 2-4
  • ROM 15-110 degrees for weeks  5-6

 

Exercises

  • Continue all of above
  • Allow submaximal isometrics of shoulder, elbow and wrist
  • Elbow active-assisted ROM 30-100

 

Modalities

  • Cryotherapy
  • E-stim
  • Scar massage and scar gel pads for protection as needed

 

PHASE 3: Weeks 7 to 12. Early Function

 

Goals

  • Initiate elbow active range of motion
  • Begin light resisted exercise
  • Increase protected elbow range of motion

 

Brace

  • Allow Free ROM in brace

 

Exercises

  • Progress shoulder exercises to include cuff strengthening (Thrower’s 10)
  • Initiate light resistance exercises for elbow flexion/extension, wrist pronation/suppination, and elbow flexion/extension to include isotonic, concentric and eccentric exercises.

 

Modalities

  • Cryotherapy
  • Scar massage

 

PHASE 4: Weeks 13-24.  Return to Functional Activities.

 

Goals

  • Improve power and endurance
  • Return to sport-specific activity

 

Brace

  • Discontinue

 

Exercises

  • Continue strengthening with progressive increases in resistance and weights
  • Plyometric strengthening program of upper and lower extremities
  • Initiate Interval Throwing Program at Week 20
  • May return to light sports and functional activities (golf, swimming, etc) at 16 weeks