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 the development of strength and endurance. Generally speaking, it requires approximately 8 months to return to competitive throwing.
PHASE 1: Post Op Days 1 to 10. Immediate Post Op Phase
- Pain control
- Limit soft tissue swelling
- Wound healing
- Begin Wrist and finger ROM
- Shoulder ROM and sub-maximal isometrics as tolerated
- Wrist flexion/extension
- Finger ROM
- Grip ball exercises
- Maintain splint and compressive wrap on the elbow
- Cryotherapy
PHASE 2: Weeks 2-6. Early Range of Motion
- Initiate Elbow assisted range of motion
- Continue shoulder, wrist, and elbow motion
- Transition to hinged elbow brace
- Allowing ROM 30-100 degrees for week 2-4
- ROM 15-110 degrees for weeks 5-6
- Continue all of the above
- Allow submaximal isometrics of shoulder, elbow, and wrist
- Elbow active-assisted ROM 30-100
- Cryotherapy
- E-stim
- Scar massage and scar gel pads for protection as needed
PHASE 3: Weeks 7 to 12. Early Function
- Initiate elbow active range of motion
- Begin light resisted exercise
- Increase protected elbow range of motion
- Allow Free ROM in a brace
- Progress shoulder exercises to include cuff strengthening (Thrower’s 10)
- Initiate light resistance exercises for elbow flexion/extension, wrist pronation/supination, and elbow flexion/extension to include isotonic, concentric, and eccentric exercises.
- Cryotherapy
- Scar massage
PHASE 4: Weeks 13-24. Return to Functional Activities.
- Improve power and endurance
- Return to sport-specific activity
- Discontinue
- 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
