Dr. Mitchell W. Larsen MD
Director of Education
Central Utah Sports Medicine
1055 N 500 W Bld C Ste 121
Provo, UT 84604
(801)373-7350

CHRONIC ULNAR COLLATERAL LIGAMENT RECONSTRUCTION USING AUTOGENOUS GRAFT PROTOCOL

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I. IMMEDIATE POST-OPERATIVE PHASE (0-3 WEEKS)

Goals: Protect healing tissue

Decrease pain/inflammation

Retard muscular atrophy

A. POST-OPERATIVE WEEK 1

Brace – Posterior splint at 90 degrees elbow flexion

Range of Motion – Wrist AROM ext/flexion

Elbow compression dressing (2-3 days)

Exercises:

• Gripping exercises

• Wrist ROM

• Shoulder isometrics (**No Shoulder ER)

• Biceps isometrics

• Cryotherapy

B. POST-OPERATIVE WEEK 2

Brace – Application of functional brace set at 30-100 degrees

Exercises:

• Initiate wrist isometrics

• Initiate elbow flexion/extension isometrics

• Continue all exercises listed above

C. POST-OPERATIVE WEEK 3

Brace – Advance brace 15-110 degrees (Gradually increase ROM 5 degrees extension/10 degrees flexion per week)

Exercises:

• Continue all exercises listed above

II. INTERMEDIATE PHASE (WEEKS 4-8)

Goals: Gradual increase in range of motion

Promote healing of repaired tissue

Regain and improve muscular strength

  A. WEEK 4

Brace – Functional brace set 10-120 degrees

Exercises:

 • Begin light resistance exercises for arm (1 lb.)

 • Wrist curls, extensions, pronation, supination

 • Elbow extension/flexion

 • Progress shoulder program, emphasize rotator cuff strengthening (Avoid external rotation until 6 ^th week)

  B. WEEK 6

Brace – Functional brace set 0-130 degrees; AROM (0-145 degrees without brace)

Exercises:

 • Progress elbow strengthening exercises

 • Initiate shoulder external rotation strengthening

 • Progress shoulder program

III. ADVANCED STRENGTHENING PHASE (WEEKS 9-13)

Goals: Increase strength, power, and endurance

Maintain full elbow ROM

Gradually initiate sporting activities

  A. WEEK 9

Exercises:

 • Initiate eccentric elbow flexion/extension

 • Continue isotonic program; forearm & wrist

 • Continue shoulder program – Throwers Ten Program

 • Manual resistance diagonal patterns

 • Initiate plymetric exercise program

  B. WEEK 11

Exercises:

    • Continue all exercises listed above

    • May begin light sport activities (i.e., golf swimming)

IV. RETURN TO ACTIVITY PHASE (WEEKS 14-26)

Goals:

Continue to increase strength, power, and endurance of upper extremity m musculature.

Gradual return to sport activities

  A. WEEK 14

Exercises:

 • Initiate interval throwing program (phase 1)

 • Continue strengthening program

 • Emphasis on elbow and wrist strengthening and flexibility exercises

  B. WEEKS 22-26

Exercises:

   • Return to competitive throwing