Ulnar Collateral Ligament (UCL) Reconstruction

General Notes: 
  • As tolerated should be understood to include with safety for the surgical procedure; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing too much too soon. If any of these occur, decrease activity level and ice.
  • During rehabilitation, if there are any neurovascular findings, please call the office.
  • Ice should be applied to the elbow for 15-20 minutes following each exercise, therapy, or training session. Return to sport is based on provider team (physician, physician assistant, athletic trainer, therapist) input and appropriate testing.
  • All times and exercises are to serve as guidelines. Progression through the protocol should be based upon criteria as opposed to dates listed and will vary depending on each individual patient. Progress should be agreed upon by the patient and his/her team of providers

Phase I: Weeks 0-1

Goals:
  • Minimize elbow pain and inflammatory response
  • Protect the integrity of the surgical repair
Brace:
  • Hinged elbow brace to be worn at all times at 60-75 degrees when sleeping or up moving around
  • Brace may be taken off while wake and in controlled settings
Therapeutic Exercises: 
  • Finger, hand and shoulder AROM encouraged
  • Short arc elbow ROM permitted as long as there is no discomfort
Modalities:
  • Frequent cryotherapy for pain and inflammation (6-8 times per day) for 15-20 minutes

Phase II: Weeks 1-4

Goals:
  • Minimize elbow pain and inflammatory response
  • Protect the integrity of the surgical repair
  • Gradually restore pain free ROM as per protocol
Brace: 
  • Hinged elbow brace open to achievable and comfortable ROM as determined by therapist (30-100 degrees)
  • Opening the brace 10 degrees/week until full ROM is achieved
ROM: 
  • Full shoulder and wrist ROM
  • Elbow 0-100 degrees by week 4
  • Progress active elbow flexion as tolerated
Therapeutic Exercise: 
  • Wrist isometrics (pronation, supination)
  • Elbow isometrics
  • Shoulder isometrics
  • Peri-scapular strengthening
  • Rotator cuff isometrics
Modalities/Education:
  • Frequent cryotherapy for pain and inflammation
  • Pre-modulated electrical stimulation as needed
  • Patient education regarding posture, joint proprioception, positioning, hygiene, etc.
Progression to Phase III: 
  • Minimal effusion
  • No pain
  • Full passive elbow extension

Phase III: Week 4-6

Goals:
  • Minimize elbow pain and inflammatory response
  • Protect the integrity of the surgical repair
  • Progress ROM
Brace:
  • Progressive open brace 0-140 degrees
ROM:
  • Elbow flexion and extension: full by week 6
  • AROM allowed
Therapeutic Exercises: 
  • ROM against gravity in all planes
  • Core strength and stability exercises
Manual Therapy:
  • Scar and soft tissue mobilization as needed 
  • Joint mobilization
Cardio:
  • Stationary bike, treadmill, and elliptical
Modalities:
  • Continue cryotherapy for pain and inflammation
Progression to Phase IV:
  • No effusion
  • Full elbow ROM

Phase IV: Weeks 6-10

ROM:
  • Full in all planes 
Therapeutic Exercises: 
  • ROM against gravity in all planes
  • Core strength and stability exercises
  • Begin eccentric elbow strengthening
  • LE strengthening without the use of arms
  • Isotonics (shoulder and wrist), elbow isotonics when full Rom achieved
     
Proprioception: 
  • Rhythmic stabilization drills at week 8
Manual Therapy: 
  • Scar and soft tissue mobilization as needed
  • Joint mobilizations as needed
Cardio:
  • Stationary bike, elliptical, treadmill, UBE
  • Light sports allow as directed by surgeon 
Modalities:
  • Continue cryotherapy for pain as needed.

Phase V: Weeks 10-14

Goals:
  • Progress strength, endurance, neuromuscular control
  • Gradual and planned buildup to prepare for return to play
Therapeutic Exercises:
  • Closed Chain exercises 
  • Progress isotonic strengthening of the shoulder and elbow 
  • Progress LE strengthening without restrictions 
  • Progress core strengthening and stability
  • Begin Interval Hitting Program at Week 12 if cleared by surgeon 
  • Begin Interval Throwing Program at Week 12 if cleared by surgeon
Proprioception: 
  • Rhythmic stabilizations 
  • Functional diagonal patterns
Cardio: 
  • Stationary bike, elliptical, UBE
  • Running 
  • Plyometric program
Manual:
  • As needed

Phase VI: Weeks 14+ Return to Sport

Therapeutic Exercises:
  • Progress ALL UE and LE strength training in both open and closed chain as tolerated 
  • Progress core strengthening and stability 
  • Sport Specific Training 
Proprioception: 
  • Progress Rhythmic stabilizations
  • Progress Functional diagonal patterns 
  • Integrate LE and multi-planar activities 
  • Progress through Interval Throwing Program 
Cardio: 
  • Stationary bike, elliptical, UBE
  • Running, cutting 
  • Plyometric program
Milestones for return to sport activities and clearance: Return to competitive throwing at 6 months when: 
  • Completion and passing of UE functional test at MD PT clinic 
  • No complaints of pain or instability 
  • Adequate ROM for task completion bilaterally 
  • Regular completion of home exercise program