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Ulnar Collateral Ligament
RehabilitationBy: Michael Cox
Bony Anatomy Humerous: Medial epicondyle- trochlea which serves as the axis of rotation for ulna on the humeorusLateral epicondyle- capitellum which serves as the axis of rotation for the radiusRadial fossa- accepts radial head during flxCoranoid fossa- accepts coranoid process during flxOlecronon fossa- accepts olecronon during ext
Ulna:Olecronon processCoranoid process
Radius:Radial headRadial tuberosity
Bony Anatomy Humeroulnar joint
Hinge jointStrong and stableAllows for flexion and extension
Humeroradial jointModified ball and socket joint
Proximal radioulnar jointAllows for pronation and supination
Ligamentous support Ulnar Collateral Ligament:
Resists valgus loads 3 bundles Anterior- taut throughout full ROM, primary restraint against valgus stress Transverse- provides little medial support Posterior- taut in flexion beyond 60 degrees
Lateral Collateral Ligament: Resists varus forces Composed of radial collateral ligament, lateral ulnar collateral ligament, annular and accessory ligament
Annular Ligament:Encases radial headDoesn’t let ulna and radius move into flexion and extension independently
Musculature Flexors:
Biceps brachii, brachioradialis, brachialis Extensors:
Triceps brachii, anconeus Forearm Pronators:
Pronator teres, pronator quadratus Forearm Supinators:
Supinator, assisted by biceps and brachioradialis
Mechanism of Injury Most ulnar collateral ligament injuries
occur in overhead throwing athletes This due to the extreme valgus stress
placed on the elbow throughout the throwing motion Acutely the UCL can also be injured
with a lateral blow to the elbow
Clinical Evaluation The patient will complain of pain on the medial aspect of the elbow
that increases with motion Tingling or numbness may be present due to the tensile force placed
on the ulnar nerve Point tender from the along the medial epicondyle Some swelling may be noticeable Positive valgus stress test
Acute treatment Refer patient for a MRI Restrict any throwing movements
Can sling if more comfortable Modalities can be used to help reduce pain and
inflammation such as ice and electrical stimulation for gate theory pain control
Surgical Patients If surgery Is needed- “Tommy John”- usually uses
palmaris longus tendon as a graft to replace UCL Immobilization wit the arm at 90 degrees of flexion for
10-14 days At this time wrist and finger ROM exercises can be
started Gripping exercises with puddy Shoulder ROM
Beginning RehabilitationWeeks 0-3
Goals:Decrease pain and inflammationImprove ROMRetard atrophy
Early Rehab- Passive ROM
Passive extension with dumbbell hanging off table (towel under joint)2 lbs.for 5-7 minutes (long duration, low intensity stretch)
Pulley flexion and extension3 sets- 10 repetitions
Clinician passive ROM
QuickTime™ and aTIFF (LZW) decompressor
are needed to see this picture.
Early Rehab- Active ROM
Wand exercises: 3 sets- 10 repetitionsflexion extensionpronation supination
Wrist ROM
Active ROMflexion, extension, pronation, supination
Early Rehab- Decreasing Pain
Joint Mobilizations- grade I and II oscillations- posterior glide
Ice Electrical Stim
- gate theory
Early Rehab- Strengthening
Isometrics flexion, extension, pronation, supination
• 3 sets of 10 repetitions holding contractions for about 5-10 seconds
• Refrain from internal and external rotation due to the valgus stress it places on the UCL
Intermediate Rehabilitation
Weeks 4-8
Goals:Improving strength and enduranceReestablishing neuromuscular controlMaintain full ROM
Criteria: Near total ROM with minimal pain
Intermediate RehabilitationIsotonic exercises
Flexionextensionpronationsupination
3 sets- 10 repetitionsStarting at 2lb dumbbell and progressing as strength increases
Wrist isotonic exercises
Rhythmic Stabilizationclinician assistedswiss ball4 sets- 20s
Intermediate RehabilitationDiagonal PNF patterns
Body Blade
straight arm and at 90
Moderate Rehabilitation
Weeks 9-13Goals: Advanced strengthening phase Increase total arm strength, power, endurance,
and neuromuscular control Prepare patient for functional return to play
activities
Criteria: Full non painful ROM Strength close to 70% of uninvolved limb
Moderate Rehabilitation
Eccentric training Theraband- biceps and triceps
Moderate Rehabilitation
Throwers 10- total arm strength Dumbbell abduction Prone dumbbell abduction Prone extension Internal rotation External rotation Theraband shoulder flexion and extension Progressive pushups Medicine ball punches- serratus anterior Diagonal D2 PNF Wrist flexion, extension, pronation, supination
Moderate Rehabilitation
PlyometricsMed ball throws one handSoccer throwChest passSide to side
Plyometric press up
Moderate Rehabilitation
Progressive medicine ball plyometricsIncreased soccer throws
8-10 reps
Side hits2 sets- 30 seconds
External rotation throws3 sets- 10 reps
Final RehabilitationWeeks 14-26
Goal: Progressive functional drills Continue to increase strength, endurance,
power Return to play
Criteria: Full ROM with no pain Full strength
Final Rehabilitation Throwing program
Increase in distance and amount of throws Enough rest time in-between session: 2-3 days
Batting practice Tees Soft toss Slow pitching Against a pitcher
Return To PlayFull ROMFull strengthNo direct pain with throwing or hittingNormal cardiovascular endurancePhysiologically ready
ArticleEmphasizes maintaining full elbow
extension earlyImportant to strengthen elbow and
wrist flexors, and pronators- importance in follow through phase
Rotator cuff strengthProgressive and essential
rehabilitation program
Summary Elbow joint has strong bony support as well as
ligamentous and capsular support Mechanism of injury is usually repetitive valgus stress Progressive rehab with certain criteria that must be met
before moving on Avoid internal and external rotation early in rehab due
to valgus stress it places on elbow Maintain cardiovascular endurance and core strength
throughout rehab Flexibility Continue strengthening once back to full participation to
decrease risk of re-injury
Questions
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