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Keywords

Clinical Practice in Athletic Training

Abstract

Introduction: The ulnar collateral ligament (UCL) is found in the medial aspect of the elbow joint capsule and is commonly injured in baseball pitchers. The common flexor tendon (CFT) is also found in the medial elbow and is less commonly injured. Both structures are key in overhead throwing, repaired via surgery, and injured due to valgus stress placed on the elbow. There is research on UCL injuries but very little on CFT injuries. There is not substantial research on the return to play protocol or rehabilitation process for either of these two structures after surgery. Patient Information: The patients for this study were two male collegiate baseball pitchers who underwent surgery for an ulnar collateral ligament (UCL) reconstruction. One of these athletes also had a common flexor tendon (CFT) repair. Patient A had to UCL reconstruction and the CFT repair. Patient B had a UCL reconstruction. Patient A likely tore his UCL over winter break and was treated for a flexor tendon strain for 3 weeks before referral to the team physician. Patient A had pain with full extension. Patient B felt a pop while pitching and had pain with a valgus force and phalangeal flexion both of which are positive signs during evaluation. Patient B was referred to the team physician for further evaluation. Both patients underwent x-ray and MRI imaging before referral to a specialist for further imaging, evaluation, and diagnosis. Interventions: MRI imaging revealed UCL sprains for both athletes and a CFT strain for one. Surgery was recommended to both patients by the specialist. After surgery, patients followed a strict rehabilitation protocol. Patients spent time in physical therapy and in the athletic training room working on strengthening around the area and mobility. Patient A remained in the brace for a week longer than Patient B. For Patient B during the first week of rehabilitation, active wrist range of motion (ROM), grip strength, and scapular ROM were rehabilitated and progressed. For Patient A during the first week of rehabilitation, scapular ROM was the only focus. Patient A was not allowed to start wrist ROM and grip strengthening exercises until 6 weeks postsurgery. Both patients worked on light passive and active ROM through the rest of phase one. Patient A was not allowed to perform wrist flexor movements for 12 weeks where Patient B began wrist ROM week 1. Both patients continued ROM rehabilitation and began the strengthening program in weeks 8-23 post-operation. In weeks 24-53, patients started the return to activity phase of rehabilitation. Patients started interval throwing programs six months post-operation. Both patients are currently in their throwing programs and are on their way to mound progression which begins at week 40. Both patients have strict guidelines on pitch velocities and distances. Outcomes: Both patients underwent surgery and rehabilitation for the same injury. One difference is the change in protocol for the patient with the CFT injury. Both patients are currently in the interval throwing protocol and have similar pitch velocity and accuracy per protocol requirements despite the ROM restrictions Patient A went under initially. Patients are to continue with their rehabilitation and return to play protocol. Clinical Bottom Line: While UCL injuries are common in baseball pitchers, CFT and UCL injuries together are not. It is important for athletic trainers to be aware of this injury because it can occur in any overhead throwing athletes. This case study is unique because it compares the recovery of one athlete who had a common injury (the UCL) to another athlete with the same injury with an additional less common injury (the CFT).

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