UCL Reconstruction (Tommy John)

Question 1

What are the 3 main precautions for UCL reconstruction?

Answer 1

1. Brace for 6 weeks
2. Avoid valgus activity in daily activities (closing a door, pulling an object to you from the side)
3. No loaded hamstring strengthening for 8 weeks if gracilis graft

Question 2

What is the general strength testing we want to stick to?

Answer 2

-Hand-held dynamometry; No RTC or shoulder testing until 12 weeks, but goal is >80% compared to contralateral shoulder

Question 3

Regarding ROM of the shoulder, what should be our goal?

Answer 3

Within 5 degrees of contralateral shoulder with all motions

Question 4

Regarding ROM of the elbow, what should be our goal?

Answer 4

pain-free ROM and the main goal is pre-injury ROM

Question 5

What is the criteria for initiating plyometrics?

Answer 5

-No earlier than 12 weeks
-Strength greater than 80% of uninvolved shoulder
-Grip strength >95% with grip dynamometer
->90% w/involved arm compared to non-involved arm during prone single arm ball drop test

Question 6

What is the main yellow flag we want to be concerned with in this rehab process?

Answer 6

persistent pinching in the elbow w/ROM

Question 7

What is Phase 1 of Rehab, and how long does it last?

Answer 7

Phase 1: Immediate Post-Op
Weeks 1-3

Question 8

What are our 2 main goals during Phase 1: Immediate Post-Op?

Answer 8

1. Protect healing tissue
2. Decrease pain/inflammation

Question 9

In Week 1, what are two main things to remember with wound care?

Answer 9

1. Check brace for rubbing/irritation
2. Compression garment at elbow to be used with physician’s consent

Question 10

What is the brace set at for week 1?

Answer 10

90 degrees

Question 11

What should we be working on ROM for week 1? (2)

Answer 11

1. Wrist AROM
2. Shoulder PROM and AROM, avoid valgus stress at elbow

Question 12

What should we be working on from a strength perspective in week 1? (3)

Answer 12

1. Gripping
2. Shoulder isometrics EXCEPT ER & IR
3. Scapular clocks/framing with manual resistance

Question 13

What can we work on from a trunk/core perspective in week 1?

Answer 13

1. Thoracic/lumbar mobility
2. Hip mobility
3. Core work

Question 14

How should we be using modalities in week 1?

Answer 14

cryotherapy, e-stim for swelling control & pain at elbow

Question 15

What is something we can do LE easily in week 1 of rehab?

Answer 15

stationary bike w/o UE support

Question 16

What is the brace setting in week 2?

Answer 16

30-90