Sara Jurek, MD
Orthopaedic Surgery
206.386.9668
Ulnar Collateral Ligament Reconstruction Physical Therapy Postoperative
Protocol
Phase I: Immediate Postoperative Phase/Inflammatory Phase (0-14 days)
Goals:
 Protect healing tissue
 Decrease pain and inflammation
 Prevent muscle atrophy
Postoperative Week 1:
 Posterior splint at 90 degrees of elbow flexion; arm sling as needed
 Wrist AROM extension/flexion; finger AROM
 Exercises: gripping exercises, wrist ROM, shoulder isometrics and ROM (except ER), biceps
isometrics
 Cryotherapy
Postoperative Week 2:
 Application of functional brace; lock at 90 degrees when not performing range of motion; arm
sling for comfort
 Increase ROM in brace 10 degrees of flexion and 5 degrees of extension every week
 Increase motion as tolerated (no full extension until weeks 3-4); gentle passive and active
ROM
 Initiate wrist isometrics
 Continue all exercises listed above
 Cryotherapy
Phase II: Intermediate Phase/Repair (Weeks 2-12)
Goals:
 Gradual increase in range of motion
 Protect repair while elbow healing
 Regain and improve muscular strength as secondary goal
Weeks 3-4
 ROM expected week 3: 15 to 115 degrees
 ROM expected week 4: 10 to 125 degrees
 Continue all exercises in brace
 Elbow ROM in brace
 Initiate active ROM wrist and elbow (no resistance)
 Begin isometric forearm exercises
 Begin grip strengthening
 Initiate light wrist flexion stretching
 Initiate active ROM shoulder
 Initiate light scapular strengthening exercises
 May begin stationary bike for lower extremity strength and endurance
Weeks 5-6
 Discontinue the brace
 Gradual increase to full ROM
 Rom expected by week 6: 0-145 (without brace)
 Initiate shoulder external rotation strengthening
 Progress shoulder program
 Progress strengthening: weight 1 lb
 Continue brace outdoors and to sleep only

Weeks 6-12
 Full ROM (0-145)
 Continue light resistance exercises for arm (1 lb): wrist curls, extensions,
pronation/supination, elbow extension and flexion
 Continue brace outdoors only as needed
Phase III: Remodeling Phase (Weeks 12-24)
Goals:
 Increase strength, power, endurance of upper extremity musculature
 Maintain full elbow ROM
 Gradually return to sporting activities
Weeks 12-24
 Initiate eccentric elbow flexion and extension
 Initiate isotonic program; forearm and wrist
 Continue shoulder program
 Manual resistance diagonal patterns
 Initiate plyometric exercises program
 Begin light sporting activities
Phase IV: Return to Activity Phase (Weeks 24-56)
Goals:
 Continue to increase strength, power, and endurance of upper extremity musculature
 Gradual return to sport program
Weeks 20-24
 Initiate throwing program (if applicable)
 Continue strengthening program
 Emphasis on elbow and wrist strengthening and flexibility exercises