Elbow UCL Injury

  • 8-14 visits total over 4 months
  • Maintain shoulder ROM while immobilized during early phase of healing
  • In addition to rehabilitating the elbow, address shoulder muscular and capsular dysfunction,including posterior capsule tightness, if indicated
  • Address scapular mal-positioning, if indicated
  • During recovery, pulling and lifting with the arm should be avoided until 2 months postoperatively
  • Minimal to no pain during or after exercises, although fatigue is OK
  • No passive ROM (PROM) unless specifically indicated by the physician

Modalities:

  1. Ice following exercises, cautious not to aggravate the ulnar nerve
  2. No phonophoresis/iontophoresis
  3. No ultrasound
  4. Transfrictional massage for tendonitis (only if indicated by physician)
  5. Soft-tissue techniques (only if indicated by physician)

Stage I (weeks 0- 1)1 visit

  1. Patient is to be immobilized at 70o elbow flexion
  2. Strengthening (1-2 visits):
    1. Grip strengthening exercises
    2. Wrist ROM
  3. Goal: Decrease pain and swelling and prevent shoulder and wrist stiffness while immobilized during the early phase of healing of the repair

Stage II (weeks 1-4) 1-2 visits

  1. Patient is to wear a hinged elbow brace (40o to 90o ROM)
  2. Strengthening/ROM
    1. Initiate elbow and wrist isometrics
    2. Scapular stabilization exercise #1
  3. Goal: Decrease pain and swelling and prevent shoulder and wrist stiffness while immobilized during the early phase of healing of the repair, initiate isometric strengthening program

Stage III (weeks 5-6) 1-2 visits

  1. Hinged elbow brace ROM increased to 20o to 110o
  2. Strengthening/ROM
    1. Light wrist and elbow isotonic exercises
    2. Shoulder strengthening exercises #1 and #4
    3. Scapular stabilization exercise #1
  3. Precautions: A. Avoid external rotation and valgus stress at elbow
  4. Goal: Increasing ROM as indicated of the elbow and gradual progression with strengthening program

Stage IV (weeks 7-8) 1-2 visits

  1. Brace is removed
  2. ROM of the elbow
    1. AROM
    2. AAROM
  3. Strengthening/ROM
    1. Progress shoulder, elbow and wrist isotonic exercises
    2. Initiate ergometric exercises for upper body
  4. Goals: Full ROM of the elbow and increase elbow strengthening program and include rotator cuff strengthening and scapular stabilization

Stage V (weeks 9-10) 1-2 visits

  1. Strengthening/ROM
    1. Eccentric strengthening exercises – wrist and elbow
    2. Aggressive shoulder strengthening (overhead, rotator cuff)
    3. Ergomatic endurance training
  2. Return to activity
    1. Throwing patterns – mirror throwing program (from Return to Throwing Protocol)
  3. Goals: Improve overall strength and implement mirror throwing program, monitor throwing mechanics

Stage VI (weeks 11-13) 1-2 visits

  1. Strengthening/ROM
    1. Aggressive upper body strengthening
    2. Plyometric training
    3. Endurance training
    4. Restoration of flexibility
  2. Continue throwing patterns – mirror throwing program (from Return to Throwing Protocol)
  3. Goals: General body and core strengthening and conditioning program, including continuing to address rotator cuff and scapular stabilization, continue to monitor throwing mechanics

Stage VII (weeks 14+) 1-2 visits

  1. Return to activity
    1. Begin Return to throwing Program (Return to Throwing Protocol)
  2. Goal:
    1. Return to elite level competition by 12-18 months

This protocol provides you with general guidelines for the rehabilitation of patients following a UCL reconstruction. Specific changes in the program will be made by the physician as appropriate for an individual patient. If you have any questions regarding the progress of the patient, the physician should be contacted.