Ulnar collateral ligament reconstruction

The patient may present with an sudden onset of elbow instability or a gradual (chronic) onset related to either a previous injury and / or long-term overuse. The latter is usually associated with sports that involved repetitive throwing (baseball, cricket) or racket sports. There may be a traction injury involving the ulnar nerve (which lies very close to the medial ligament) as a result of the elbow being unstable, and this often manifest as pins & needless or numbness in the little finger, and / or weakness of forearm or hand muscles.

If the problem does not resolve with a trial of relative rest, physiotherapy and protective taping for the elbow, then a surgical repair / reconstruction of the ligament may be required.

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Immediately post surgery

You will wake up in the recovery area with the arm in a POP cast and sling. The wounds will be closed with stitches. There will be a nurse present monitoring your recovery from the surgery, as well as administering pain killers as required. You will remain in the recovery area until discharged home or to another ward. Most of these operations are peformed as “day surgery”.

Your surgeon will talk to you before you leave the hospital. He will explain to you how the surgery went and answer any questions you may have.

You will be asked to phone Dr. Porter’s rooms to confirm the time and date of your first post-operative check-up. The wounds must be kept clean and dry until review, and the dressings left intact.

First post-operative check up

This will usually be within 7-14 days of the surgery. The cast and dressings will be removed, and the wounds checked. Any stitches will be removed.

The splint may be replaced with a hinged brace allowing ROM from 30-90dg flexion, or you will be asked to remain in the sling, and only come out of the sling to perform exercises with the permitted range.
You will be given a second post-operative check up for 6 weeks post surgery.

Between the first and second post-operative check up
You will be allowed to move the elbow between the ranges of 30dg to 90dg flexion.
This is increased to 15-105 dg from weeks 3-5 (post surgery)

Second post-operative check up

Your surgeon will reassess the elbow, and in particular the healing of the UCL. He will refer you to physiotherapy, or wrist to the physiotherapist if you have already starting seeing one.

After 6 weeks

Formal physical therapy is commenced at 6 weeks, if not earlier. Elbow ROM is increased to full, while strengthening is allowed for the wrist, hand and shoulder (including the rotator cuff).

Final review
Your surgeon will review you before return to full sporting activity. Throwing sports may take 9-12 months to return to without restriction.

Throwing sports

By 12 weeks the patient is doing intensive physiotherapy including plyometrics, trunk strengthening and scapular strengthening. At 4 months the patient is allowed to commence throwing. Initially only every second day and exercises are done before and after all throwing.

Throwing distance starts at 20m and increases slowly in terms of both duration of throwing and distance. Once pain free throwing is possible to distances of 80ms, pitching from the mound is allowed and this is usually around 9 months post surgery. Competitive pitching is usually not possible until one year post surgery.

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