Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

Table 1 Key factors for improving outcomes in ulnar collateral ligament injuries at various time points

Time point	Target points for improved outcomes
Pre-op	Patient selection
Intra-op	Do not transpose nerve unless symptoms present preoperatively
	Docking > Jobe (complications)
Post-op	Sport 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 period	Phase	Goal
Day 0-7	Splinted at 90° flexion	Early healing of graft and fascial sling for nerve transposition
Weeks 1-5	Hinged elbow ROM brace	Protect healing tissues from valgus stress
Weeks 3-4	Light resistance isotonic exercises	Develop dynamic stabilization of the medial elbow
Week 6	Thrower’s Ten Program
Weeks 8-9	Progressive resistance exercises incorporated
Week 12	Advanced Thrower’s Ten Program
	Two-hand plyometric drills
Week 14	One-hand plyometric drills
Week 16	Interval throwing program
Week 22/24	Throwing from the mound
Months 9-12	Return to competitive throwing

ROM: Range of motion.

Table 3 High speed steels postoperative rehabilitation protocol following ulnar collateral ligament reconstruction with palmaris longus autograft

Time period	Treatment strategies	Goal
Day 0-10	Splinted or hinged elbow ROM brace at 60 degrees flexion	Promote graft healing, reduce pain, and swelling
Weeks 1-4	Hinged elbow ROM brace at all times No PROM Elbow AROM in brace	Restore ROM 30°-90° Promote graft healing Independent home exercise program
Weeks 4-6	Continue brace wear at all times Avoid PROM Avoid valgus stress Continue AROM in brace Isometric exercises of deltoid, wrist, elbow	Restore ROM 15°-115° Minimal pain and swelling
Weeks 6-12	Minimize 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 adequate	Restore full ROM All upper extremity strength 5/5 Begin to restore muscular endurance
Week 8	Begin internal/external rotation strengthening Begin forearm pronation/supination strengthening
Weeks 12-16	Pain free plyometric exercises Advance internal/external rotation to 90/90 position Neuromuscular drills Plyometric program Endurance training	Restore full strength and flexibility Prepare for return to activity
Week 16	Begin interval throwing program
Weeks 16-36	Avoid pain with throwing or hitting Avoid loss of strength or flexibility Continue flexibility training Continue strengthening program	Return to activity Prevent reinjury
Week 20	Begin hitting program

ROM: Range of motion; AROM: Active range of motion; PROM: Passive range of motion.

Table 4 Angular velocity by sport

Sport	Baseball	Softball	Football	Javelin	Tennis
Angular velocity	2400°/s	570°/s	1760°/s	1900°/s	982°/s