UCL Tears
Inflammatory Response Phase
The immediate response to injury is vasoconstriction, the body tries to isolate the compromised area to prevent further injury. This immediate vasoconstriction can last 5 to 10 minutes.
Then histamine is released from the injured mast cells causing vasodilation and increasing the blood flow to the area. Leukotrienes and prostiglandins are responsible for margination, this is a process in which leukocytes adhere along the cell walls of the injured area. Platelets typically don't adhere to vascular cell walls, however in physical injury collagen fibers are exposed allowing for platelet adheration coupled with leukocytes. This process begins to form a clot to the area in which bleeding occurs. Clot formation forms around 12 hours post-injury and is complete within 48 hours.
In the case of a ulnar collateral ligament sprain there is variation ot the inflammatory response phase depending on the grade and type of sprain. In higher grade sprains and avulsion fracutures there is more damage done to the ulnar collateral ligament and surrounding tissues.
The primary goals for this phase of the rehabilitation plan is to manage and control swelling/pain, establish structural integrity, gain pain free range of motion, and gain flexibility.
When a UCL tear is suspected place ice around the surrounding area, elevate, and compress to limit the swelling and prevent secondary hypoxia to the area. Make sure to take precautions when icing around the medial aspect of the elbow, such as a pre-wrap around the elbow. Direct contact can cause secondary injury such as freezing of the superficial ulnar nerve. If the surgical option is chosen the arm will be placed in a protective brace or cast for approximately 10 days. After 10 days the patient will begin gentle range of motion exercises progressing to achiveive full pain free range of motion. Towards the end of this stage isometric strengthening can begin.
Rehabilitation exercises for this phase include:
Range of motion for the shoulder, elbow, and wrist
Passive range of motion for the elbow should start as soon as possible. In order to gain full range of motion, stretching should also occur at the shoulder and wrist, due to the orgin and insertion points of the muscles that surround the elbow.
Isometric strengthening
Isometric holds can be benefical during this stage to help maintain strength without needing full pain free range of motion. Avoid any external rotation of the elbow/shoulder during this time.
Short term goals: Reduce swelling & pain, establish structural integrity.
Long term goals: Increase range of motion to 85% of normal (comparitive to the bilateral elbow)
While this stage normally only lasts up to 72 hours, cardiovascular maintence is still important. Biking is a great option for athletes with UCL tears as it involves little upper extremity involvment.