Dr. David Lintner - Orthopedic Sports Medicine Surgeon

ULNAR COLLATERAL LIGAMENT RECONSTRUCTION

DAVID LINTNER, MD

This rehabilitation protocol has been developed for the patient following an ulnar collateral ligament reconstruction surgical procedure. This procedure is normally performed on the overhead athlete or throwing athlete with severe instability or acute trauma to the UCL. The most frequently utilized tissue is a palmaris longus autograft tendon. The protocol is divided into phases. Each phase is adaptable based on the individual and special circumstances.

The overall goals of the surgical procedure and rehabilitation are to:

· Control pain and inflammation

· Regain normal upper extremity strength and endurance

· Regain normal elbow range of motion

· Achieve the level of function based on the orthopedic and patient

goals

The physical therapy should be initiated 10 to 14 days post-op, to be decided by Dr. Lintner. The supervised rehabilitation is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.

Important post-operative signs to monitor include:

· Swelling of the elbow and surrounding soft tissue

· Abnormal pain, hypersensitive-an increase in night pain

· Severe range of motion limitations

· Weakness in the upper extremity musculature

Return to activity requires both time and clinical evaluation. To most safely and efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Functional evaluation including strength and range of motion testing is one method of evaluating a patient’s readiness to return to activity. Return to intense activities following an ulnar collateral ligament reconstruction requires both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.

Phase 1: Week 1-4

UCL Protocol

WEEK EXERCISE GOAL

1-3 ROM 0-90° day 10

AROM

Wrist flexion/extension

Finger flexion/extension

Passive range of motion

Elbow flexion/extension wk 2

NO FULL EXTENSION UNTIL WEEK 3 TO 4

STRENGTH

Grip strengthening with putty or ball

Initiate shoulder isometrics-NO ER

Initiate submaximal bicep isometrics wk 1

Initiate submaximal wrist isometrics wk 2

Initiate submaximal elbow flex/ext isometrics wk 2

BRACE

Elbow immobilizer with arm sling b 0-90° wk 1

Functional brace 30-100° wk 2

15-110° wk 3

MODALITIES

E-stim as needed

Ice 15-20 minutes

GOALS OF PHASE:

· Promote healing of tissue

· Control pain and inflammation

· Initiate light muscle contraction

· Independent in HEP

Phase 2: Week 4-8

UCL Protocol

WEEK EXERCISE GOAL

4-8 ROM 0-145° wk 6

Continue ROM activities from previous

phase, initiate elbow AROM week 6

STRENGTH

Continue to progress strength from Phase 1

Initiate light resistance exercises

Initiate light wrist flexion and extension

Initiate forearm pronation and supination

Initiate light elbow extension and flexion

Progress shoulder strengthening program

Progress rotator cuff program, avoid ER until wk 6

BRACE

Functional brace 10-120° wk 4

0-130° wk 6

MODALITIES

Ice 15-20 minutes

GOALS OF PHASE:

· Gradual increase of ROM

· Control pain and inflammation

· Progressive strength and endurance training

Phase 3: Week 8-12

UCL Protocol

WEEK EXERCISE GOAL

8-12 ROM Full ROM

Continue all ROM activities from

previous phases

STRENGTH

Initiate eccentric elbow flexion/extension

Progress elbow flexion/extension isotonics

Progress shoulder isotonics

Initiate manual resistance PNF patterns

Initiate light bilateral plyometric program

Initiate light sports specific training week 11

BRACE D/C wk 6

Functional brace discharged week 6 or as

noted by Dr. Lintner

MODALITIES

Ice 15-20 minutes

GOALS OF PHASE:

· Full elbow ROM

· Maximize strength and endurance

· Minimize pain and inflammation

· Initiate return to sports/functional training program

· Enhance proprioception and arthrokinematics

Phase 4: Week 12-24

UCL Protocol

WEEK EXERCISE

12-24

12-24 ROM

Continue all stretching and ROM activities from

previous phases

STRENGTH

Continue with all strengthening activities increasing

weight and repetitions

Initiate interval throwing program wk 20

Initiate single arm eccentric activities

Return to competitive throwing 7 to 9 months

MODALITIES

Ice 15-20 minutes as needed

GOALS OF PHASE:

· Maximize power, strength, and endurance of upper extremity

· Return to sports specific activity/functional activity

· Maximize proprioception and arthrokinematics

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