Dr. Edwin Spencer - The Shoulder and Elbow Center



Ulnar Collateral Ligament Reconstruction (Tommy John Procedure)Pathology and Treatment: The ulnar collateral ligament connects the inside of the humerus to the ulna. It maintains the stability of the elbow when throwing. It can be injured by repetitive throwing or at times from a single hard throw. Partial injuries can be rehabilitated but complete tears usually require reconstruction if the player is to continue throwing at a competitive level. The decision to perform a reconstruction should not be taken lightly as the rehabilitation to return to throwing takes an extended period of time and dedication on the part of the athlete.When the decision is made to perform a reconstruction, a tendon graft is used to reconnect the medial aspect of the humerus to the ulna. We currently use a docking technique utilizing either the palmaris longus tendon from the forearm or if absent a split flexor tendon (FCR). Goals and Guidelines: The goal is to allow the ligament to heal with subsequent mobilization and strengthening. While the protocol focuses on the operative arm, the athlete and therapist should concomitantly work on lower extremity and core strengthening as well as conditioning. For the first 2 weeks, the arm is in a posterior splint. Once the splint is removed, the patient will go into a hinged brace and work on regaining range of motion. While in the brace, the patient is allowed to use the arm for activities of daily living. At 6 weeks, strengthening is initiated and a throwing program is started at 4 months. 0-2 Weeks-Remain in posterior splint2-6 Weeks-Hinged elbow brace is placed and the patient works on slowly improving flexion, extension, pronation and supination6-8 Weeks-Start elbow flexion/extension and pronation/supination strengthening-Start wrist strengthening8-10 Weeks (Alternate the muscle groups that are being strengthened)-Start periscapular strengthening with seated rows and lower rows working on rhomboid and lower trapezius strengthening to position the shoulder blade-Start 4 Way Theraband Strengthening for the rotator cuff-Start deltoid strengthening with forward and lateral raises10-12 Weeks-Start light bench-press and lat pulls -Start TVA’s and Six Pack Back-Start Thrower’s 10 exercises12-16 Weeks-Continue to work on strengthening-Start Concentric and Eccentric Resisted Throwing-Start Rebounder Throwing-Push-up into wall with ball under unilateral hand focusing on scapular retraction. Progress to stability ball on a table while performing a push-up, then progress to stability ball on the floor. Do not forget to set shoulder blades into the correct position.16 Weeks-Start Phase I Interval Throwing Program ................
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