Ulnar Collateral Ligament Rehabilitation PPT
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Transcript Ulnar Collateral Ligament Rehabilitation PPT
Ulnar Collateral
Ligament Rehabilitation
By: Michael Cox
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
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
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
Musculature
Flexors:
Biceps brachii, brachioradialis, brachialis
Extensors:
Triceps brachii, anconeus
Forearm Pronators:
Pronator teres, pronator quadratus
Forearm Supinators:
Supinator, assisted by biceps and brachioradialis
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
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
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
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
Beginning Rehabilitation
Weeks 0-3
Goals:
Decrease pain and inflammation
Improve ROM
Retard atrophy
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
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Early Rehab- Active ROM
Wand exercises: 3 sets- 10 repetitions
flexion
extension
pronation
supination
Wrist ROM
Active ROM
flexion, extension, pronation, supination
Early Rehab- Decreasing
Pain
Joint Mobilizations- grade I and II oscillationsposterior glide
Ice
Electrical Stim
- gate theory
Early RehabStrengthening
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
Intermediate
Rehabilitation
Weeks 4-8
Goals:
Improving strength and endurance
Reestablishing neuromuscular control
Maintain full ROM
Criteria: Near total ROM with minimal pain
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
Diagonal PNF patterns
Body Blade
straight arm and at 90
Intermediate
Rehabilitation
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
Moderate Rehabilitation
Eccentric training
Theraband- biceps and triceps
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
Moderate Rehabilitation
Plyometrics
Med ball throws one hand
Soccer throw
Chest pass
Side to side
Plyometric press up
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
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
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
Return To Play
Full ROM
Full strength
No direct pain with throwing or hitting
Normal cardiovascular endurance
Physiologically ready
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
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
Questions
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