UCL TEARS IN THE THROWING
ATHLETE: FROM SURGERY TO
RETURN TO THROWING
Evidence Based Practice
12
thAnnual DFW Sports Medicine Symposium
March 21
st, 2015
Agenda
1. Mechanism of Injury/Throwing Mechanics that Contribute
to UCL Tears
– Craig Garrison, PhD, PT, ATC, SCS
2. Surgical Reconstruction of the UCL Tear in the Throwing
Athlete
– John Conway, MD
3. Post-operative Management following UCL Reconstruction
-
Craig Garrison, PhD, PT, ATC, SCS
4. When is it OK for my Athlete to Begin Throwing? Pre-return
to Throwing and Interval Throwing Program
– Mike Macko,
PT, DPT, OCS, MTC
Objectives
1. Identify key anatomical and biomechanical factors as they
relate to MOI to the UCL in the throwing athlete
2. Recognize key factors for success of early post-operative
management of a UCL reconstruction in the throwing athlete
3. Recognize importance of restoration of lower extremity
balance in the throwing athlete following UCL reconstruction
4. Identify best practices when returning the UCL reconstructed
throwing athlete to sport
5. Recognize the appropriate healing and criteria-based
timeframes for an interval throwing program following UCL
reconstruction in the throwing athlete
Mechanism of Injury/Throwing
Mechanics that Contribute to UCL
Tears
Epidemiology
MLB UCLR 2000-2011
Adapted from Conte, 2015 ASMI
Adapted from Conte, 2015 ASMI
Epidemiology
Adapted from Conte, 2015 ASMI
Epidemiology
MLB UCLR 2000-2011
Adapted from Conte, 2015 ASMI
Epidemiology
MLB UCLR 2000-2011
Epidemiology
Epidemiology
•
Increasing rate of UCL
tears in
pre-adolescent and
adolescent baseball
players
•192 enrolled in past 4 years – Ben Hogan
Mechanism of Injury/Throwing
Mechanics
•
Commonly injured during
the throwing motion
–late cocking to acceleration phases of the throw
•valgus forces are high – 64
Nm
–34.5 Nm UCL
»(Fleisig et al., AJSM.,
1995)
–64 Nm UCL
»Werner et al., 1993
• UCL Tensile Failure - 13 to 32 Nm
Mechanism of Injury/Throwing
Mechanics
Mechanism of Injury/Throwing
Mechanics
Mechanism of Injury/Throwing
Mechanics
•
Maximum Leg
Lift
– Loss of balance on stance leg– Hips move toward home-plate too early
Mechanism of Injury/Throwing
Mechanics
Stride Foot Contact (SFC)
↑ Hor Abd
Glove Side early opening
Mechanism of Injury/Throwing
Mechanics
Stride Foot Contact (SFC)
Max ER at Shoulder
Mechanism of Injury/Throwing
Mechanics
Stride Foot Contact (SFC)
•
Knee Flexion
–
flexed at SFC
–
moving toward
extension at Rel
–
collapse on the front
side?
Mechanism of Injury/Throwing Mechanics
Age 2006 USA Baseball Guidelines 2010 Little League Baseball Regulations
Daily Limits 17-18 N/A 105/day 15-16 N/A 95/day 13-14 75/game 95/day 11-12 75/game 85/day 9-10 50/game 75/day 7-8 N/A 50/day Weekly Limits 15-18 N/A
31-45 pitches = 1 day rest 46-60 pitches = 2 days rest 61-75 pitches = 3 days rest 76+ pitches = 4 days rest 13-14 125/week; 1000/season; 3000/year
21-35 pitches = 1 day rest 36-50 pitches = 2 days rest 51-65 pitches = 3 days rest 66+ pitches = 4 days rest 11-12 100/week; 1000/season; 3000/year
9-10 75/week; 1000/season; 2000/year
7-8 N/A
Example limits for number of pitches thrown in games
Mechanism of Injury/Throwing
Mechanics
No significant difference between FB and CB in any FPM
Sisto et al AJSM 15, 1987
Types of Pitches
Adapted from John Conway, MD lecture
Surgical Reconstruction of the
UCL Tear
John Conway, MD
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