The UCL: The Two Bundles

The ulnar collateral ligament is a structure that keeps the humerus and the ulna in a normal relationship. The most common cause of an injury to the UCL is repetitive stress to the elbow. Most commonly it is cause by repetitive throwing. You will most likely see this injury happen in throwing sports, such as baseball. The injury can start to happen over time or the ligament can pop from too much force.

Once inside the elbow the unlar nerveis recognized, lifted out, and moved to provide greater access to the joint. This is the "funny bone" nerve and it runs inside the ulnar groove.

Connecting the humerus to the scapula is a ball-and-socket joint called the glenhumeral joint which allows the arm to move in a circular motion, as well as up and out from the body. A joint at the highest point of the shoulder, called the acromioclavicular (AC) joint, gives human beings the ability to raise their arm above their head. The acromioclavicular joint is creating by the joining of the clavicle and the scapula. A group of tendons and muscles in the shoulder make up the rotator cuff which stabilizes the shoulder and keeps the humerus in the glenoid, a shallow fissure in your scapula. I selected you as one of my patients due to your shoulder problems due to the fact that in my senior year of high school I had to go to a physical therapist for my shoulder.

The surgery was frist performed in 1974 by orthopedic surgen Dr. Frank Jobe, was named after the first baseball player to undergo this surgery; Tommy John was the major league pitcher whose record of 288 career victories ranks seventh all time. This procedure is made to help a person with UCL also known as ulnar collateral ligament also known as the elbow. The procedure is common among collegiate and professional athletes in several sport, but most in baesball. The procedure goes as follow, the patient’s arm is open up aroung the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus ones of the elbow. The doctor then gets a tendon such as the palmaris tendon from the forearm of the same or opposite elbow, the patellar tendon, or a cadeveric tendon. Which are ten woven in a figure eight pattern through the holes and anchored. The ulnar nevre is usually moved to prevent pain as scar tissue can appy pressure to the nerve.

Ulnar collateral ligament tear (UCL) contains a sprain to inner elbow ligament. Once significant stress is placed upon the UCL, an injury occurs. However, two UCL injury treatments include icing and excluding throwing activates for six weeks. Icing reduces inflammation, whereas not throwing influences healing. In addition, injury prevention exercises include heavy dumbbell farmer walk, squishy ball squeezes, and dumbbell wrist curls. Heavy dumbbell farmer walks specify athlete to walk Five yards while holding dumbbells. Exercise is succeeded four days per week with three sets of five, progressing into weight increases. Squishy ball squeezes require athletes to grip squishy ball frequently contracting then releasing. Exercise is succeeding three

Ulnar collateral ligament injury is a type of elbow injury that develops from repeated overhand throwing movements (overuse). This motion places a lot of stress on the two strong bands of tissue (ligaments) that hold your elbow joint in place. The ulnar collateral ligament (UCL) is a main ligament located on the inside of your elbow. Over time, repetitive overhand throwing can damage the UCL.

A, an unloaded knee. B, when valgus loading is applied, the medial collateral ligament becomes taut and lateral compression occurs. C, this compressive load, as well as the anterior force vector caused by quadriceps contraction, causes a displacement of the femur relative to the tibia where the lateral femoral condyle shifts posteriorly and the tibia translates anteriorly and rotates internally, resulting in ACL rupture. D, after the ACL is torn, the primary restraint to anterior translation of the tibia is gone. This causes the medial femoral condyle to also be displaced posteriorly, resulting in external rotation of the tibia. ( 63 )

The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) are located inside the knee joint. The ACL and PCL form an ‘X’ behind the kneecap (patella), with the ACL resting in front of the PCL. Both of these ligaments are responsible for controlling the back and forth motion of the knee joint; however, the ACL is responsible for stabilizing the kneecap ). In addition, the ACL is responsible for preventing the shin bone (tibia) from sliding forward on the thigh bone (femur). The ACL provides the knee with stability while an individual pivots or twists. This ligament is critical because without it, performing any kind of rotational activity is impossible, particularly when it comes to playing sports like soccer and basketball.

The ACL originates from the medial and anterior aspect of the tibial plateau and runs superiorly, laterally, and posteriorly toward its insertion on the lateral femoral condyle. Together with the posterior cruciate ligament (PCL), the ACL guides the instantaneous center of rotation of the knee, therefore controlling joint kinematics. To a lesser degree, the ACL checks extension and hyperextension. The ACL is not as strong as the posterior cruciate ligament (PCL), and it is less strong at its femoral origin than at its tibial insertion. Muscles surrounding the knee joint contribute to knee stabilization during lower extremity movements.

The recent uprising of the UCL surgery is largely due to the overuse especially in youth baseball players. The continuous micro tears in the UCL without proper rest continue to break down the ligament until surgical repair is necessary. The beginning phase of the rehab usually lasts about 4-8 weeks with a gradual progression of increasing ROM, manage pain and swelling, and preventing atrophy. The next phase lasting through weeks 9-12 continues to increase ROM, improve strength in arm, shoulder, and core. The third part of the rehab progresses from week 13-20. Goals consist of increasing overall strength and endurance, achieve full ROM of elbow, and begin low level plyometric. ROM should be at full beginning around week 10 of the rehab. The

Compensatory Approach: Prevent further deformation of the ulnar drift with swan neck deformities to maintain client’s present ROM in B (UE).

When was the last time you thought about your ulnar collateral ligament? Have you ever thought about stretches you should do for your elbow and arm before throwing anything? How about what even makes your elbow work? These are things I never took into consideration before my injury.

Humerus, Radius, Ulana (arms): To support your wrist and fingers when hitting the ball, it also provides power when hitting the ball.

The knee joint consists of four ligaments, two intra-capsular which are the ACL and the PCL and two extra-capsular ligaments including the MCL and LCL. The ACL is an extremely strong stabiliser which prevents anterior displacement of the knee. The ACL is a ligament and therefore connects one bone to another, the femur with the tibia. The ACLs origin is from the anterior intercondylar eminence of the tibia (home,2017) and the fibres pass upwards, backward and laterally inserting into the lateral condyle of the femur.

In this phase the athlete is standing in a neutral position holding the ball. The metatarsophalangeal and interphalangeal (great and lesser toes) are held at slight flexion pressed against the ground by an isometric contraction of the flexor halluces longus, flexor digitorum longus, flexor digitorum longus. The ankle is plantar flexed using an isometric contraction of the gastrocnemius and the soleus. The tibiofermoral (knee) joints are slightly flexed by a isomectric contraction of the quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius). The acetabularfemoral (hip) joint is held at a postion of slight flexion through an isometric contraction of the biceps femoris, pectineus, iliacus, and the psoas. The intervertebral (lumbar) joint is extended by an isometric contraction using the erector spinae. The atlantooccipital (cervical spine) joint is flexed by an isometric contraction erector spinae. Both scapulothroracic (shoulder girdle) joint is protracted by an isometric contraction of the serratus anterior and pectoralis minor. The glenohumeral (shoulder) joint is at internal rotation by an isometric contraction using the pectoralis major, latissimus dorsi, teres major, and the subscapularius. The humeroulnar (elbow) joint is at 90 degrees of flexion by an isometric contraction using the biceps brachii, brachioradialis, and brachialis. The radiocarpal (wrist left and right)