Current concepts in rehabilitation following ulnar collateral ligament reconstruction

Todd S Ellenbecker, Kevin E Wilk, David W Altchek, James R Andrews, Todd S Ellenbecker, Kevin E Wilk, David W Altchek, James R Andrews

Abstract

Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments.

Keywords: baseball; elbow; overhead athlete; rehabilitation; throwing; ulnar collateral ligament.

Conflict of interest statement

No potential conflict of interest declared.

Figures

Figure 1.
Figure 1.
A low-load, long-duration stretch into elbow extension, performed using light resistance.
Figure 2.
Figure 2.
The Thrower’s Ten Program is designed to exercise the major muscles necessary for throwing. The Program’s goal is to be an organized and concise exercise program. In addition, all exercises included are specific to the thrower and are designed to improve strength, power, and endurance of the shoulder complex musculature.
Figure 3.
Figure 3.
Manual proprioceptive neuromuscular facilitation upper extremity D2 patterns with rhythmic stabilization.
Figure 4.
Figure 4.
Isokinetic wrist extension/flexion training at fast contractile velocities.
Figure 5.
Figure 5.
External rotation at 90° of abduction with exercise tubing, manual resistance, and rhythmic stabilizations.
Figure 6.
Figure 6.
Plyometric external rotation 90/90 throws for posterior rotator cuff strengthening.
Figure 7.
Figure 7.
Plyometric internal rotation throws at 90° of abduction.
Figure 8.
Figure 8.
Plyometric internal rotation throws at 0° of abduction.
Figure 9.
Figure 9.
Plyometric wrist flips and snaps for the wrist flexors.

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