Nonoperative Management of Ulnar Collateral Ligament Injuries in the Throwing Athlete: A Framework for Return to Throwing.

Abstract

Background: Ulnar collateral ligament (UCL) injuries in throwing athletes result from repetitive valgus stress to the elbow in a flexed position. Muscular dysfunction of the forearm and shoulder musculature is commonly associated with UCL injuries. Nonoperative rehabilitation should generally start with a rest period, followed by progressive strengthening of the upper extremity, and eventually, a systematic throwing program.

Indications: Nonoperative management is first line for UCL injuries. Trained rehabilitation professionals, including physical therapists or athletic trainers, should be involved early and guide the progression of exercise throughout the recovery process.

Technique description: In the first 1 to 2 weeks, the goals include strengthening rotator cuff, scapulothoracic, and forearm musculature while protecting the damaged UCL by avoiding valgus stress. Weeks 3 to 4 progress strengthening to more demanding movements, utilizing larger muscle groups while introducing shoulder internal rotation strengthening. The goals of weeks 5 to 6 are to increase the speed of movement as the athlete prepares to return to more throwing-like activity. The athlete can begin a progressive, monitored throwing program as early as 7 weeks.

Results: The purpose of this video is to provide a suggested framework for the progression of rehabilitative exercises in athletes with UCL injuries.

Discussion/conclusion: A well-designed return to throwing program respects tissue load tolerance. It is important that the athlete remain pain-free throughout the rehabilitation process. This highlights the need for well-trained professionals to guide the return to throwing process, so that modifications can be made when needed.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.