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 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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