The stresses on the UCL are greater with specific types of pitches, such as the slider and split-fingered pitch. The repetitive nature of overhead-throwing activities such as baseball pitching, javelin throwing, and football passing further increase the susceptibility of UCL injury by exposing the ligament to repetitive microtraumatic forces. These stresses approach the ultimate failure load of the ligament with each throw. The elbow experiences a tremendous amount of valgus stress during overhead throwing. Injuries to the ulnar collateral ligament (UCL) of the elbow are becoming increasingly more common in overhead-throwing athletes, although the higher incidence of injury may be due to our increased ability to diagnose these injuries. Furthermore, specific nonoperative and postoperative treatment guidelines for the thrower’s elbow are also discussed. The purpose of this chapter is to provide an overview of general rehabilitation principles for elbow instability. This may result in valgus extension overload with the posterior compartment leading to osteophyte formation, stress fractures of the olecranon, or physeal injury. The posterior compartment is subject to tensile, compressive, and torsional forces during acceleration and deceleration phases. Thus, the medial aspect of the elbow undergoes tremendous tensile (distraction) forces, and the lateral aspect of the elbow is forcefully compressed during the throwing motion.
m, which exceeds the ultimate tensile strength of the ulnar collateral ligament.In addition, the valgus stress applied to the elbow during the acceleration phase of throwing is 64 N These are caused by chronic stress overload or repetitive microtraumatic stress observed during the overhead pitching motion as the elbow extends at over 2300 degrees/sec, producing a medial shear force of 300 N and lateral compressive force of 900 N. The repetitive overhead motion involved in throwing is responsible for unique and sport-specific patterns of injuries to the elbow. Management of elbow instability requires rehabilitation for the entire kinetic chain, including the scapula, upper limb, trunk and pelvis (core), and lower extremities to ensure the athletes’ return to high-level sports participation.Īthletes employing overhead movements often experience injuries to the elbow. Postoperative management requires a balance between stability to avoid stress on ligamentous repair and mobility to minimize loss of elbow motion. Postsurgically, therapists need to receive detailed information about ligament reconstruction to initiate an appropriate early motion program. The Thrower’s Ten Program consists of an upper limb-strengthening program and plyometric exercises that are slowly initiated and commonly used in nonoperative management of elbow instability. The medial elbow is exposed to tensile forces, and the lateral elbow is forcefully compressed during the throwing motion, therefore both ligament complexes are at risk for injury.