Agenda. Objectives 3/18/2015 UCL TEARS IN THE THROWING ATHLETE: FROM SURGERY TO RETURN TO THROWING

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UCL TEARS IN THE THROWING

ATHLETE: FROM SURGERY TO

RETURN TO THROWING

Evidence Based Practice

12

th

Annual 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

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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

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Adapted from Conte, 2015 ASMI

Epidemiology

MLB UCLR 2000-2011

Adapted from Conte, 2015 ASMI

Epidemiology

MLB UCLR 2000-2011

Epidemiology

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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

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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

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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

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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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