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Ulnar Collateral Ligament Repair Protocol

Ulnar Collateral Ligament Repair Protocol

Phase I: Immediate Post-Surgical Phase (Days 1 - 21)

  • Goals: Protect healing tissue, decrease pain and inflammation, increase scar mobility, prevent muscular atrophy
  • Exercises: 
    • Week 1: Gripping exercises, wrist AROM/PROM, sub-maximal pain-free biceps isometrics and shoulder isometrics (w/ no shoulder ER isometrics)
      • Posterior splint applied in operating room at 90° elbow flexion and neutral forearm
    • Week 2: Progress above exercises, begin sub-maximal and pain-free wrist, elbow flexion and elbow extension isometrics
      • Hinged elbow braced applied at 30-100° available elbow ROM
    • Week 3: Progress above exercises
      • Advance hinged elbow brace to 15-110°

Phase II: Intermediate Phase (Weeks 4 - 8)

  • Goals: Gradual increase in ROM and strength, promote healing of surgically repaired tissue
  • Exercises:
    • Weeks 4-5: Resisted (1-2lb) wrist flexion, extension, pronation, and supination exercises, elbow flexion/extension AAROM/AROM, rotator cuff strengthening (avoiding ER until 6th week)
      • Hinged elbow brace set at 10-120°
    • Week 6: AROM 0-145° without brace, initiate ER strengthening, progress shoulder and elbow strengthening program
      • Hinged elbow brace set at 0-130°

Phase III: Advanced Strengthening (Weeks 9 - 13)

  • Goals: Increase strength, power, and endurance, maintain full elbow ROM, gradual return to functional activities
  • Exercises: 
    • Weeks 9-10: Progress above exercises, begin eccentric elbow flexion/extension exercises, initiate plyometrics program, manual resistance in diagonal patterns
    • Week 11: Progress above exercises, begin functional activities (reaching, lifting, etc.)

Phase IV: Return to Activity Phase (Weeks 14 - 26):

  • Goals: Continue to improve strength, power, and endurance, gradual return to functional activities
  • Exercises: 
    • Weeks 14-22: Progress above exercises, initiate endurance program, begin interval throwing program for athletes, global UE flexibility 
    • Weeks 22-26: Return to competitive throwing and full working/functional capacity 


Ulnar Collateral Ligament of the Elbow Reconstruction Using Autogenous Graft Protocol. Brigham and Women's Hospital Web site.