Adam Seidl, MDBoard Certified Orthopaedic SurgeonShoulder and Elbow Specialist

UCL Repair

Phase I:  Protect Repair (0-2 weeks)

• Splint and postop dressing remains in place for the first 2 weeks.
• Incision will be inspected by the surgeon at 2 weeks.
• Gentle hand/wrist/shoulder ROM
• Scapular stabilizing exercises
• Gentle rotator cuff strengthening

Phase II: Protected ROM (2-4 weeks)

• Hinged Elbow Brace (HEB) applied at 2-week follow-up visit
• HEB locked at 90 when upright
• Brace unlocked for ROM exercises

• Week 2: 30º to 90º
• Week 3: 20º to 100º
• Week 4: 10º to 110º
• Full A/PROM pronation
• Full AROM supination, no supination stretching
  • Therapeutic Exercises
• Gripping exercises
• Hand/Wrist/Shoulder ROM
• Shoulder isometrics (No shoulder IR- stress on medial elbow)
• Biceps isometrics
• Elbow extension isometrics
• Scar Tissue Mobilization and edema control
• Begin work on kinetic chain coordination and strength (trunk/hip/core)

Phase III: Full PROM (5-6 weeks)

• HEB unlocked full ROM
• Advance ROM:

• Progress to full PROM
• Maintain full ROM pronation/supination
• Progress to AROM supination

• Therapeutic Exercises
  • Begin light resistance (1 lb)
    • Wrist curls, extension, pronation, supination
    • Elbow flexion/extension
  • Progress shoulder program
    • Emphasis on cuff strengthening
    • No IR against resistance
  • Initiate shoulder strengthening with light dumbbells
  • Initiate Thrower’s Ten Program when full ROM achieved
  • Continue kinetic chain modalities

Phase IV: Full A/PROM (7-8 weeks)

• Discontinue hinged elbow brace
• Start AAROM and progress to full AROM elbow
• Therapeutic Exercises
  • Progress elbow strengthening exercises
  • Initiate shoulder IR strengthening
  • Progress shoulder program
  • Initiate diagonal patterns
  • Initiate plyometric program (2-hand then 1-hand)
  • Advance Thrower’s Ten Program

Phase V: Maintain Full ROM (9-12 weeks)

• Maintain Full ROM
• Advance shoulder, elbow, wrist strength and endurance
• Therapeutic Exercises
  • Advance shoulder, elbow, wrist strengthening as tolerated
  • Scapular stabilization and endurance
  • Begin machine-based resistance (seated chest-press, seated row, biceps/triceps
  • Begin interval hitting program week 10

Phase VI: Regain Function (13+ weeks)

• Continue Full A/PROM
• Begin and advance throwing program
• Begin swimming at 13 weeks
• Return to golf (13 weeks if lead arm, 16 weeks if trailing arm)
• Therapeutic Exercises
  • Progress to heavier load lifting as tolerated per functional goals/needs
  • Continue focus on kinetic chain optimization
  • Continue Thrower’s Ten Program
  • Initiate interval throwing program

Return to Sport Notes:

• Average return time to hitting: 4 months
• Average return to pitching: 5-7 months  

Return to Throwing:

• Suggested warm up of 1 set of exercises (including Thrower’s Ten and neuromuscular control drills) prior to throwing.
• Criteria to begin a long toss program.
  • Full nonpainful ROM(within 5° of nonthrowing shoulder, shoulder horizontal adduction of 40° or greater, elbow and wrist ROM WNL)
  • Strength(MMT, handheld dynamometer or iso): ER/ IR of 72%-76%, ER abduction ratio 68% to 73%, Throwing shoulder compared to nonthrowing- IR greater than 115%, ER greater than 95%, elbow flexion/ extension 100%115%, wrist strength 100%-115%
  • Clinical exam:no pain, tenderness, or effusion. Negative laxity (prone valgus stress and milking maneuver, negative shoulder & elbow special tests
  • Functional tests:
    • Prone ball drop- 110% (Position-prone, shoulder abducted to 90°, elbow extended, palm facing floor. Athlete instructed to quickly release & catch a 2lb plyometric ball as many times as they can in 30 seconds. Scoring- record total successful catches per arm. Goal to have 110% of the catches in throwing armcompared to nonthrowing. Example if nonthrowing arm is 20, goal for throwing arm is 22)
    • One-arm ball throws against wall with 2lb plyoball for 30 seconds without pain and ability to maintain in 90°/90° position
    • Throws into Plyoback rebounder with 1lb plyometric ball for 30 seconds without pain
    • Single leg step downs for 30 seconds with good pelvic and lower extremity control that is symmetrical between limbs
    • Prone plank for time- Goal time of 90 seconds or greater
  • Interval throwing gradually increased from 45 ft to 60 ft and then by 30 ft up to 180 ft
  • Program indicates throwing at each stage for 2-3 separate practices without pain or symptoms before progressing to the next stage. (13 stage for non-pitchers, 15 stages for pitchers) For details, see Reinold 2002. • Return to sport is typically between 5-7 months post-surgery and is decided upon by ability to complete return to throwing tests, the rehabilitation team’s opinion, and the physician’s opinion.

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