ULNAR COLLATERAL LIGAMENT RECONSTRUCTION

Rehabilitation Protocol


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
Exercises
Modalities
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
Brace
Exercises
Modalities
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
Brace
Exercises
Modalities
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
Brace
Exercises
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
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