Surgical Considerations for the UE - Medial Elbow (UCL) Flashcards
What are the 2 different types of procedures for UCL Repair?
UCL Reconstruction (Tommy John)
- Full reconstruction of the ligament
- Use of a tendon graft (Palmaris Longus or Gracilus Tendon)
UCL Repair with Internal Brace
- For acute tears
- Partial Tears with good tissue quality
- Cuts rehab time in half
What are the Primary, Secondary, and Tertiary Structures affect by Surgery with UCL?
Primary: Bone
Secondary: Ulnar Nerve
Tertiary: Surrounding tissue disrupted by surgery to access to primary tissue
With a UCL Repair, the patient is given a hinged elbow brace to protect the repair and the ulnar nerve. The surgeon will guide the progression of the ROM, what is the progression for weeks 1-6?
Week 1: Brace locked at 90° of elbow flexion
Week 2: Brace is between 30-110°
Week 3: Brace is between 10-125°
Week 4: Brace is between 0-145°
Week 6: Discontinue brace
After a UCL Repair, what motions should be avoided?
- Valgus Stress on the Elbow
- Shoulder ER for 6 weeks
What is the difference with the Anterior and Posterior Fibers of the UCL?
Anterior Fibers: Limit Valgus in elbow flexion and extension
Posterior Fibers: Limit Valgus in elbow flexion
With Post-op UCL Surgery, what should be done with the Physical Examination?
- Integumentary Examination (Before and after each treatment session)
- Neurologic Examination (Testing for ulanr nerve involvement)
- Elbow AROM (Tested to patient tolerance; No PROM)
- Shouler/wrist AROM
- Palpation (TTP of forearm, upper arm, and shoulder musculature)
What are Prognostic Factors with UCL Surguries?
- Natural Hx (Bodies ability to heal itself over time)
- Primary Tissue healing times (Bone)
- Return to sport/activity timelime
(highly variable based on pts activity level and participation; primary seen with overhead athletes)
What are the Precautions of Phase 1 of Therapy?
- Wear hinge brace at all times (Time frame with vary based on surgeon)
- NO PROM
- No shoulder ER
- No lifting, pulling, or pushing with affected arm
- Focus on pain contol
- Retard muscle atrophy in hand, wrist and shoulder. Also normalize ROM
This is “Protected Motion” Phase
What Interventions are done with Phase 1 of Therapy?
- Manual Therapy (Gentle soft tissue massage)
- Home exercise (Elbow and wrist AROM; Gentle Ball squeezes)
- Education on pain management and post-op restrictions
How long does Phase 1 of Therapy Typically last?
0-3 weeks
What are the Precautions with Phase 2 of Therapy?
- Wear hinge brace as directed by surgeon
- Protect elbow from valgus force
This is the “Progressive Loading/Strengthening” Phase
What Interventions are done in Phase 2 of Therapy?
- Manual Therapy (STM to elbow/shoulder musculature and incision)
- Continue to progress AROM
- Introduce strengthening of the elbow/forearm/shoulder/scapular muscularture (Avoiding shoudler ER or any exercise that creates valgus force)
- Throwers Ten Program can be initiated
- Education on activty modification to avoid provoking or aggravating Sx
How long does Phase 2 of Therapy typcially last?
4-8 weeks
What are the precautions of Phase 3 of Therapy?
No Increase in pain with exercise/activities
This is the “Functional and Sensorimotor Training” Phase
What Interventions are done in Phase 3 of Therapy?
- Progress UE and periscapular strengthening exercises (Introduce speed with strength exercise; Exercise should create tolderance to valgus and compression loading)
- Pre-plyometric and plyometic exercises
- Introduce functional/sports activities as tolerated
- Education on activty modification to avoid provoking or aggravating Sx
Remodeling of UCL will require progressive loading with valgus and compressive forces
