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Ulnar Collateral Ligament Rehabilitation By: Michael Cox.

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Presentation on theme: "Ulnar Collateral Ligament Rehabilitation By: Michael Cox."— Presentation transcript:

1 Ulnar Collateral Ligament Rehabilitation By: Michael Cox

2 Bony Anatomy  Humerous: Medial epicondyle- trochlea which serves as the axis of rotation for ulna on the humeorus Lateral epicondyle- capitellum which serves as the axis of rotation for the radius Radial fossa- accepts radial head during flx Coranoid fossa- accepts coranoid process during flx Olecronon fossa- accepts olecronon during ext  Ulna: Olecronon process Coranoid process  Radius: Radial head Radial tuberosity

3 Bony Anatomy  Humeroulnar joint Hinge joint Strong and stable Allows for flexion and extension  Humeroradial joint Modified ball and socket joint  Proximal radioulnar joint Allows for pronation and supination

4 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 head Doesn’t let ulna and radius move into flexion and extension independently

5 Musculature  Flexors:  Biceps brachii, brachioradialis, brachialis  Extensors:  Triceps brachii, anconeus  Forearm Pronators:  Pronator teres, pronator quadratus  Forearm Supinators:  Supinator, assisted by biceps and brachioradialis

6 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

7 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

8 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

9 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

10 Beginning Rehabilitation Weeks 0-3 Goals:  Decrease pain and inflammation  Improve ROM  Retard atrophy

11 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 extension 3 sets- 10 repetitions  Clinician passive ROM

12 Early Rehab- Active ROM Wand exercises: 3 sets- 10 repetitions flexion extension pronation supination Wrist ROM Active ROM flexion, extension, pronation, supination

13 Early Rehab- Decreasing Pain  Joint Mobilizations- grade I and II oscillations- posterior glide  Ice  Electrical Stim - gate theory

14 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

15 Intermediate Rehabilitation Weeks 4-8 Goals:  Improving strength and endurance  Reestablishing neuromuscular control  Maintain full ROM  Criteria: Near total ROM with minimal pain

16 Intermediate Rehabilitation Isotonic exercises Flexion extension pronation supination 3 sets- 10 repetitions Starting at 2lb dumbbell and progressing as strength increases Wrist isotonic exercises Rhythmic Stabilization clinician assisted swiss ball 4 sets- 20s

17 Intermediate Rehabilitation Diagonal PNF patterns Body Blade straight arm and at 90

18 Moderate Rehabilitation Weeks 9-13 Goals:  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

19 Moderate Rehabilitation  Eccentric training  Theraband- biceps and triceps

20 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

21 Moderate Rehabilitation  Plyometrics  Med ball throws one hand  Soccer throw  Chest pass  Side to side Plyometric press up

22 Moderate Rehabilitation  Progressive medicine ball plyometrics  Increased soccer throws  8-10 reps  Side hits  2 sets- 30 seconds  External rotation throws  3 sets- 10 reps

23 Final Rehabilitation Weeks 14-26 Goal:  Progressive functional drills  Continue to increase strength, endurance, power  Return to play Criteria:  Full ROM with no pain  Full strength

24 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

25 Return To Play  Full ROM  Full strength  No direct pain with throwing or hitting  Normal cardiovascular endurance  Physiologically ready

26 Article  Emphasizes maintaining full elbow extension early  Important to strengthen elbow and wrist flexors, and pronators- importance in follow through phase  Rotator cuff strength  Progressive and essential rehabilitation program

27 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

28 Questions ??????????

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