Copyright ©The Author(s) 2016.
World J Orthop. Apr 18, 2016; 7(4): 229-243
Published online Apr 18, 2016. doi: 10.5312/wjo.v7.i4.229
Table 1 Key factors for improving outcomes in ulnar collateral ligament injuries at various time points
Time pointTarget points for improved outcomes
Pre-opPatient selection
Intra-opDo not transpose nerve unless symptoms present preoperatively
Docking > Jobe (complications)
Post-opSport specific rehabilitation
Isokinetic testing
Return to throw program
Daily stretching exercises
Table 2 Airfield surface movement indicator postoperative rehabilitation protocol following ulnar collateral ligament reconstruction with palmaris longus autograft
Time periodPhaseGoal
Day 0-7Splinted at 90° flexionEarly healing of graft and fascial sling for nerve transposition
Weeks 1-5Hinged elbow ROM braceProtect healing tissues from valgus stress
Weeks 3-4Light resistance isotonic exercisesDevelop dynamic stabilization of the medial elbow
Week 6Thrower’s Ten Program
Weeks 8-9Progressive resistance exercises incorporated
Week 12Advanced Thrower’s Ten Program
Two-hand plyometric drills
Week 14One-hand plyometric drills
Week 16Interval throwing program
Week 22/24Throwing from the mound
Months 9-12Return to competitive throwing
Table 3 High speed steels postoperative rehabilitation protocol following ulnar collateral ligament reconstruction with palmaris longus autograft
Time periodTreatment strategiesGoal
Day 0-10Splinted or hinged elbow ROM brace at 60 degrees flexionPromote graft healing, reduce pain, and swelling
Weeks 1-4Hinged elbow ROM brace at all times No PROM Elbow AROM in braceRestore ROM 30°-90° Promote graft healing Independent home exercise program
Weeks 4-6Continue brace wear at all times Avoid PROM Avoid valgus stress Continue AROM in brace Isometric exercises of deltoid, wrist, elbowRestore ROM 15°-115° Minimal pain and swelling
Weeks 6-12Minimize valgus stress Avoid PROM by the clinician Avoid pain with exercises Continue AROM Low intensity, long duration stretch for extension Isotonic exercises of the scapula, shoulder, elbow, forearm and wrist Eccentric training when strength is adequateRestore full ROM All upper extremity strength 5/5 Begin to restore muscular endurance
Week 8Begin internal/external rotation strengthening Begin forearm pronation/supination strengthening
Weeks 12-16Pain free plyometric exercises Advance internal/external rotation to 90/90 position Neuromuscular drills Plyometric program Endurance trainingRestore full strength and flexibility Prepare for return to activity
Week 16Begin interval throwing program
Weeks 16-36Avoid pain with throwing or hitting Avoid loss of strength or flexibility Continue flexibility training Continue strengthening programReturn to activity Prevent reinjury
Week 20Begin hitting program
Table 4 Angular velocity by sport
Angular velocity2400°/s570°/s1760°/s1900°/s982°/s