Ulnar Collateral Ligament Sprain of the Elbow Tommy John’s Surgery Rehabilitation Program Devin Solvik Therapeutic Exercises For Athletic Training Professions and Athletes

Anatomy Humerus Ulna Anterior Band Intermediate Band Posterior Band

Mechanism of Injury UCL can become stretched frayed or torn Improper throwing mechanics Number of pitches thrown Percent of injury

Throwing mechanics Valgus stress 1 2 3 4 5 6 Valgus torque

Pre-Surgery Treatment RICE Electric Stimulation Ultra Sound Heat

Pre-Surgery Rehabilitation Range of Motion Exercises Strength Core

Tommy John Surgery Performed by Dr. Frank Jobe in 1974. Named after major league pitcher Tommy John. New tendon Woven in a figure 8 pattern Attaches to ulna and humerus

Post-Surgery Treatments Ice Elevation Compression Immobilization

Post Surgery RANGE OF MOTION Wand flexion/extension Passive extension- light medicine ball Pulley-passive flexion/extension AROM Wrist- circumduction, flexion/extension

Wand Flexion/ Extension Good helps the bad

Passive Extension- light medicine ball Allow medicine ball to assist with elbow extension

Pulley Passive flexion/extension Make sure movements are controlled

AROM wrist- circumduction, flexion/extension

Post-Surgery Resistive Exercises Isometrics- elbow flexion/extension Theraband/theratubing- elbow flexion/extension Dumbbell- elbow flexion/extension Therabar- pronation/supination Hand Web Putty Squeeze

Isometrics- elbow flexion/extension There should be no movement within the elbow joint during this exercise

Theraband/theratubing-elbow flexion/extension Do through entire rang of motion.

Dumbbell- elbow flexion/extension

Therabar- pronation/supination Uninjured arm will stabilize one end of thera-bar

Have patient flex and extend fingers against resistance Hand Web Have patient flex and extend fingers against resistance

Completely open and close hand using a slow and controlled manner. Putty Squeeze Completely open and close hand using a slow and controlled manner.

Prognosis Percent of complete recovery 85%-92% Begin throwing at 16 weeks Field players 6 months of rehabilitation Pitchers 1 year of rehabilitation

Risk Factors Re-injury Damage to ulnar nerve Infection Area of injury

References … American Journal Sports Medicine Current Concepts in Rehab Defining Safe Rehab Diagnosis and Treatment Muscle Splitting of the UCL Optimizing elbow Rehab Rehab Following Elbow Surgery Rehabilitation of Throwers UCL Reconstruction