Skip to content

Patients › Rehabilitation

Kakaitan ng Siko

PDF Evidence

Rehabilitasyon pagkatapos ng operasyon para sa kawalan ng katatagan ng siko, na sumasaklaw sa mga pinsala sa lateral (terrible triad / LCL) at sa throwing (medial UCL), na nakabase sa protektadang maagang paggalaw imbes na immobilisasyon.

Illustrasyon ng siko na nagpapakita ng lateral at medial collateral ligaments na nagpapatibay sa kasukasuan.
Ang mga collateral ligament sa panlabas (lateral) at panloob (medial) na bahagi ng siko, na pinag-aayos o pinoprotektahan matapos ang pinsala sa instability. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protokol na ito ay gabay sa iyong paggaling pagkatapos ng operasyon para sa elbow instability kay Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Binabanggit nito ang dalawang uri ng instability, at ipapaliwanag ng iyong surgeon kung alin ang angkop sa iyo:

  • (A) Isaksak sa gilid (outer-side): tulad ng "terrible triad" injury, fracture-dislocation, o pagkukumpuni ng lateral collateral ligament (LCL). Pinatitibay ang mga sugatang ito upang hindi na madulas o lumilipat ang siko.
  • (B) Isaksak sa paghahagis (medial, inner-side): pagkukumpuni o rekonstruksyon ng ulnar collateral ligament (UCL), karaniwan sa mga atleta na naghahagis.

Ang buong plano ay nakabase sa isang ideya: protektadang maagang paggalaw, hindi immobilisasyon. Ang mahabang panahon sa cast o splint ang pangunahing sanhi ng permanenteng matigas na siko, kaya ang layunin ay magsimula ng ligtas at mabilis na paggalaw. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang siko ay pinapanatili sa tamang posisyon ng mga ligamento sa loob at labas ng kasukasuan. Kapag nasugatan ang mga ito (dahil sa dislokasyon, fracture-dislocation, o paulit-ulit na paghahagis), maaaring maging unstable ang kasukasuan. Ang operasyon ay nag-aayos o nagre-reconstruct ng mga nasirang istruktura upang muling maayos ang pagkakasakay ng kasukasuan.

Ang paraan ni Dr. Hirpara ay nakaiiwas sa makapal na panlabas na hinged brace. Kung matatag ang repair sa buong range ng galaw noong panahon ng operasyon, magkakaroon lamang ka ng magaan na sling para sa kumportableng suporta at magsisimula agad sa paggalaw ng siko sa maagang yugto, sa loob ng ligtas na mga posisyon. Kung kailangan ng karagdagang proteksyon ang stability, maaaring maglagay ng internal joint stabiliser noong panahon ng operasyon: isang maliit na internal hinge na pinapanatili ang siko sa tamang reduced position mula sa loob habang pinapayagan pa ring yumuko at tuwid ito sa maagang yugto. Dahil internal ang proteksyon, naiiwasan pa rin ang panlabas na arc-limiting brace. Kung gagamitin, karaniwang tinatanggal ang internal na device na ito kapag gumaling na ang mga ligamento, sa humigit-kumulang apat hanggang anim na buwan.

Para sa pamamahala ng sugat, pamamaga, at peklat, tingnan ang gabay ng klinika tungkol sa wound care.

Ang pinakamahalagang ugali sa paggaling na ito ay panatilihin ang paggalaw sa loob ng iyong ligtas na range habang pinapahalagahan ang mga posisyon na hinihingi ng iyong surgeon na iwasan. Ang mga ehersisyo sa ibaba ang iyong simula.

Mga Precautions at limitasyon

Ang mga posisyon na dapat protektahan ay nakadepende sa uri ng sugat na iyong nararanasan. Kumpirmihin ng iyong surgeon at therapist ang iyong mga ito.

Para sa lateral (panlabas na gilid) na sugat (terrible triad / LCL):

  • Gawin na panatilihin ang iyong forearms na nakaturn palad-pababa (pronated) para sa paggalaw; ito ay nagse-seat ng joint at nagpoprotekta sa outer repair.
  • Gawin na mag-ehersisyo habang ang iyong braso ay nasa harap ng iyong katawan, o nakahiga habang ang braso ay umaabot patungo sa kisame kung hinihingi, upang tumulong ang gravity na panatilihin ang joint na magkasama.
  • Huwag hayaang bumaba ang braso sa gilid (iwasan ang shoulder abduction) o kunin ang bigat sa pamamagitan nito nang maaga; ang gravity ay maaaring hilain ang repair papalayo.
  • Huwag pagsamahin ang ganap na pagtutuwid ng siko kasama ang palad-pataas (supinated) na forearm hanggang sa i-clear ng iyong surgeon (mga 16 linggo); ito ang posisyon na maaaring magdulot ng pag-slide ulit ng joint.
  • Huwag itulak o i-stretch ang siko patungo sa sakit, at iwasan ang weight-bearing at contact loading sa unang ilang buwan.

Para sa throwing (medial, panloob na gilid) na sugat (UCL):

  • Gawin na panatilihin ang iyong forearm na biased palad-pataas (supinated) o neutral, ayon sa direksyon.
  • Huwag iload ang shoulder patungo sa outward (external) rotation nang maaga; ito ay nagpapataas ng stress sa inner repair. Karaniwang i-iwasan ito hanggang sa mga 6 linggo.

Mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout, para sa pagbawi ng ligtas na galaw at pagpapanatili ng pag-andar ng iyong kamay, forearms, at balikat habang protektado ang siko. Simulan at i-progreso lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong terapistang pisikal; ang ligtas na posisyon at saklaw ng galaw ng forearm ay nakadepende sa iyong tiyak na pinsala.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang klinikal na protokol para sa iyong pisyoterapeuta o hand therapist. Ito ay isinulat sa dalawang track dahil ang dalawang sugat ay may iba't ibang proteksyon. Ang bawat yugto ay may mga pamantayan: umunlad kapag natupad ang mga milestone, hindi lamang base sa kalendaryo.

Bago ang paggamot, suriin ang x-ray, operation report, at past medical history ng pasyente, at makipag-ugnayan sa treating surgeon tungkol sa stability na nakamit sa operasyon, ang safe arc at forearm rotation, at kung may implanted na internal joint stabiliser. Hindi gumagamit si Dr. Hirpara ng external hinged brace: ang through-range stable repair ay pinamamahalaan sa simpleng sling na may early motion para sa kaginhawaan; kung kailangan protektahan ang stability, ang internal joint stabiliser ang nagpapanatili ng reduction sa loob habang pinapayagan ang extension hanggang sa kaginhawaan.

Track A — Terrible triad / fracture-dislocation / LCL (LUCL) repair

Layunin: Isang matatag at concentrically na-reduce na siko na gumagalaw nang maaga; pigilan ang posterolateral rotatory re-subluxation.

Mga pangunahing paalala sa buong maagang yugto:

  • Panatilihin ang forearm na pronated para sa isolated lateral injury (pinapapaligoy ang lateral structures at inaayos ang radiocapitellar joint). Kung parehong columns ang na-repair, panatilihin ang forearm sa neutral; ang supination ay pinapayag lamang kapag ang siko ay nakabaluktot ng ~90°.
  • Iwasan ang varus stress at shoulder abduction: ang gravity ay naglalagay ng varus load sa lateral repair. Gawin ang active range of motion habang ang braso ay nasa harap ng katawan, o supine-overhead (gravity-reduced) kung ang repair ay tenuous.
  • Walang full-extension-with-supination hanggang ~16 linggo (nagre-reproduce ng pivot-shift).
  • Walang weight-bearing / closed-chain loading sa loob ng 8–16 linggo.

Linggo 0–2: Early motion. Simpleng sling para sa kaginhawaan. Simulan ang digit, wrist at shoulder active range of motion agad. Simulan ang elbow active at active-assisted range of motion hanggang sa kaginhawaan mula araw 2–3, forearm pronated, braso sinusuportahan sa harap ng katawan (o supine-overhead kung ang repair ay tenuous, upang ang gravity ay mag-compress ng joint). Kung may naka-install na internal joint stabiliser, umunlad sa full comfortable extension nang maaga; ang device ay nagpoprotekta sa reduction; walang external brace ang ginagamit.

Linggo 2–6: Ibalik ang arc. Umunlad sa full comfortable flexion at extension (extension hanggang sa kaginhawaan sa buong yugto; ang internal stabiliser, kung mayroon, ay nagpapahintulot dito). Panatilihin ang pronation bias; iwasan ang varus loading. Mga kriteriya para umunlad: buong passive arc na nakuha na, walang re-subluxation sa examination o x-ray, sakit ≤3/10.

Linggo 6–12: Pagpapalakas. Kapag clinically at radiographically na-heal na (~linggo 6), simulan ang progressive strengthening; ipakilala ang static-progressive splint kung may contracture na umuunlad. Patuloy na iwasan ang varus load. Ang internal stabiliser, kung ginamit, karaniwang pinapanatili hanggang sa ligament healing.

Linggo 12–20+: Advanced / pagbabalik. Progressive resistance; pagbabalik sa heavy labour. Contact at overhead sport sa humigit-kumulang 6–9 buwan (at pagkatapos ng anumang internal-stabiliser removal). Patuloy na iwasan ang varus-loaded strengthening.

Track B — Pagpapagaling/pagpapatibay ng UCL (medial) para sa mga nagtatake

Ito ay isang kronikong problema sa medial na bahagi dahil sa sobrang paggamit. Ang kagustuhan ni Dr. Hirpara ay walang panlabas na hinged brace: ang suture-tape internal-brace augmentation (pagpapagaling) o ang tendon graft (pagpapatibay) ang nagbibigay ng proteksyon, at ang rehabilitasyon ay nakatuon sa pagtatake. Ang forearm ay nakatuon sa supination/neutral; iwasan ang resisted shoulder external rotation hanggang ~ika-6 na linggo, dahil ito ay naglalagay ng valgus load sa graft.

Pagpapagaling na may internal-brace augmentation (pinabilis, na tugma sa walang panlabas na brace na pamamaraan):

  • Maagang protektadong galaw hanggang sa kumportable, linggo 0–4 (buong arc sa ~ika-6 na linggo).
  • Thrower's Ten program mula sa ~ika-3 na linggo; plyometrics mula sa ~ika-6 na linggo.
  • Interval throwing program mula sa ~ika-11 na linggo; pagbabalik sa sports sa ~5–7 buwan.

Track ng pagpapatibay (graft), kung gagamitin (mas mabagal):

  • Buong arc sa ~ika-6 na linggo; interval throwing sa linggo 14–16; pagtatake mula sa mound hindi bago ang 6 buwan; kompetitibong pagbabalik sa sports karaniwan ay 9–16 buwan.

Pagbabalik sa trabaho at gawain

Ang bilis ng iyong pagbabalik ay nakadepende sa kung anong sugat ang iyong naranasan at sa mga pangangailangan ng iyong trabaho o isport.

  • Lateral na sugat (terrible triad / LCL): ang magaan na mga gawain sa opisina at sariling pag-aalaga ay maaaring simulan nang maaga, sa loob ng mga ligtas na posisyon. Ang pagsasanay sa pagpapalakas ng kalamnan ay karaniwang nagsisimula sa humigit-kumulang 6 linggo pagkatapos na klinikal at sa x-ray ay magaling na ang siko. Ang mga isport na may kontak at pagtaas ng kamay sa itaas ng ulo ay karaniwang pinapagpaliban hanggang humigit-kumulang 6–9 buwan, at pagkatanggal ng panloob na tagapagtatag ng kasukasuan kung may isang nakabitin. Iwasan ang pagdadala ng bigat sa pamamagitan ng braso o pag-load nito palabas sa gilip hanggang sa ipahintulot ng iyong doktor.
  • Throwing injury (UCL): sa isang repair na may internal-brace-augmented, ang isang estrukturadong interval throwing program ay karaniwang nagsisimula sa humigit-kumulang 11 linggo, na may pagbabalik sa isport sa humigit-kumulang 5–7 buwan. Pagkatapos ng reconstruction, ang pagbabalik sa kompetitibong pagtatapon ay mas mabagal, karaniwang 9–16 buwan.

Ang pagmamaneho ay muling sisimulan kapag ikaw ay may komportableng, ligtas na kontrol ng braso labas ng sling at ang iyong doktor ay kumpirmado na ito ay angkop sa review. Ang iyong therapist ay magpapatuloy sa iyong pagpapalakas at mga drill na espesipiko sa isport o trabaho patungo sa iyong mga indibidwal na layunin.

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng sakit pagkatapos ng operasyon at pag-aalaga sa sugat. Ang iyong patuloy na paggaling ay indibidwal na pinamumunuan ng iyong pisyoterapeuta o therapist para sa kamay ayon sa pag-unlad ng iyong siko at kung anong sugat ang nakuha mo. Ang buod ng ebidensya para sa mga kliniko na may access sa protocol na ito ay naka-imbak kasama ang pahinang ito.

Reviewed by Dr Kieran Hirpara · 18 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Elbow Instability — Rehabilitation Evidence (Lateral / Terrible Triad / LCL and Throwing / UCL)

Topic scope: Post-operative rehabilitation after surgery for elbow instability, in two distinct tracks: (A) complex lateral instability — "terrible triad" / fracture-dislocation and lateral (ulnar) collateral ligament [LCL/LUCL] repair & reconstruction for posterolateral rotatory instability (PLRI); and (B) overhead-throwing ulnar (medial) collateral ligament [UCL] reconstruction & repair ("Tommy John").

Defining principle: the crux of every track is protected motion, not immobilisation. Restore enough stability to permit early range of motion (within ~1 week), because prolonged immobilisation is the dominant cause of disabling flexion contracture and stiffness. Dr Hirpara's stance: he does not use an external hinged brace. A repair that is stable through-range at surgery is managed with a simple sling for comfort plus early motion to comfort within positional precautions. Where stability needs protecting, he implants an internal joint stabiliser (an internal hinge) that holds the elbow reduced from the inside while permitting full flexion and extension to comfort — so the patient still moves early without an external arc-limiting brace. The device is typically removed once the ligaments have healed (~4–6 months). The published external-hinged-brace extension-block arcs below are retained as reference for what they represent biomechanically, not as Dr Hirpara's management.

(A) Terrible triad / complex fracture-dislocation / LCL (LUCL) repair & reconstruction

Forearm-rotation rule (the key precaution)

  • Lateral-sided (LCL/LUCL) injury → keep the forearm PRONATED. Pronation tightens the lateral structures and seats the radiocapitellar joint, protecting the lateral repair. Terminal extension is performed pronated; supination near full extension reproduces the pivot-shift and is avoided.
  • Medial-sided (MCL/UCL) injury → keep the forearm SUPINATED (Rockwood & Green; Green's Operative Hand Surgery).
  • If both columns are repaired (many terrible triads), the forearm is held neutral.
  • Early supination, when allowed, is done only with the elbow flexed to ~90° (flexion stabilises the ulnohumeral joint and protects the lateral reconstruction).

Phased timeline

  • Week 0–2 — Immediate post-op / early motion. Posterior splint at ~90° flexion in injury-appropriate forearm rotation for 7–14 days in the published protocols; the practical aim is early motion. Begin digit/wrist/shoulder AROM immediately and gentle elbow AROM/AAROM in the surgeon-defined stable arc within days (Brigham fracture-dislocation guideline starts elbow/forearm AROM at day 2–3). A supine/overhead protocol is an option where the lateral repair is tenuous — gravity compresses and stabilises the ulnohumeral joint (Green's; Lee 2013).
  • Week 2–6 — Protected motion / restore the arc. Published external-hinged-brace protocols open an extension block ~10°/week, forearm pronated (Denver/Eichinger: 30° at wk2 → 20° wk3 → 10° wk4 → 0° wk5), reaching full extension by ~week 5–6. Dr Hirpara replaces this external brace with a simple sling (through-range stable repair) or an internal joint stabiliser permitting extension to comfort. Precautions: avoid varus stress and shoulder abduction; avoid combined full-extension-with-supination for up to ~16 weeks; no weight-bearing/closed-chain for 8–16 weeks.
  • Week 6–12 — Intermediate / strengthening. Full PROM, joint mobilisations. Strengthening starts ~week 6 once clinical and radiographic healing is confirmed (Brigham PRE 6–8 wk; Rockwood & Green). Static-progressive splinting if a contracture is developing (Müller 2013).
  • Week 12–20+ — Advanced / return. Progressive resistance; avoid varus-loaded strengthening. Contact/overhead sport often delayed to ~6–9 months for reconstruction (Green's: unrestricted use ≥6 months for graft incorporation; Eichinger: up to 9 months).

Nonoperative (stable terrible triad) caveat: if the joint is concentrically reduced with a stable arc to ≥30° of extension (no radial-head block, small coronoid), nonoperative early-motion management is reasonable (Rockwood & Green / Chan criteria; Najd Mazhar 2017).

(B) UCL reconstruction / repair — throwing athlete ("Tommy John")

Rehabilitation is uniformly described in 4 phases (Brotzman-Wilk lineage; ASMI/Andrews; Mass General). The forearm is biased toward supination/neutral (medial-sided injury); no shoulder external-rotation loading early (it valgus-loads the graft).

  • Phase I — Week 0–3. Posterior splint at 90° week 1, then progressive ROM. Wrist AROM, gripping, submax shoulder isometrics (no ER), submax biceps isometrics from week 1–2.
  • Phase II — Week 4–6/8. Progress to full ROM by ~week 6. Light wrist/forearm strengthening, rotator-cuff isotonics; resisted shoulder ER avoided until ~week 6 to protect the graft.
  • Phase III — Week 6/9–12/13. Progressive elbow/forearm strengthening, eccentrics from ~wk9, Thrower's Ten, plyometrics ~wk9 if appropriate.
  • Phase IV — Week 14–26+. Interval throwing program ~week 14–16; long-toss ramp 45→60 ft, +30 ft increments to 180 ft; mound throwing ≥6 months; return to competitive throwing ~6 months for return-to-throw, but full competitive RTS typically 9–16 months (≥12 months a common criterion). ~83–97% RTS in throwers.

Internal-brace–augmented UCL REPAIR (accelerated track) — the recent shift

For acute/avulsion tears with good tissue, UCL repair with internal brace allows a markedly accelerated protocol (Dugas/ASMI; SLU/JOSPT 2019):

  • Mobilise early to comfort; full/unrestricted ROM by ~wk4, brace off by wk6.
  • Thrower's Ten from ~wk3; plyometrics from ~wk6.
  • Interval throwing as early as ~wk11; return to sport ~5–7 months (vs ≥9–12+ for reconstruction). Dugas 2025 (AJSM) head-to-head: repair ~2–3 weeks accelerated for ROM/strengthening and ~5–9 weeks accelerated for starting the interval throwing program, with comparable outcomes in appropriately selected athletes.

Phased-timeline summary

Phase / window Track A — lateral (terrible triad / LCL) Track B — throwing (UCL, internal-brace repair)
Weeks 0–2 Sling for comfort; elbow AROM/AAROM to comfort from day 2–3, forearm pronated, arm supported in front / supine-overhead Early protected motion to comfort; submax shoulder (no ER) + biceps isometrics; grip/wrist work
Weeks 2–6 Restore full comfortable arc; extension to comfort (internal stabiliser permits); maintain pronation, avoid varus Progress to full arc by ~wk6; Thrower's Ten from ~wk3
Weeks 6–12 Strengthening once healed (~wk6); static-progressive splint if contracture Plyometrics from ~wk6; progressive strengthening
Weeks 12–20+ Progressive resistance; contact/overhead sport ~6–9 mo Interval throwing ~wk11; RTS ~5–7 mo (reconstruction: 9–16 mo)

Key controversies

  1. Early vs protected motion (complex instability). Strong consensus favours early motion (≤7 days), BUT the two 2024 systematic reviews (Ahmed Kamel, JSES; Larwa, Shoulder & Elbow) found no RCT and high heterogeneity (immobilisation 1–76 days, weighted mean ~42–47). "Early" is biomechanically favoured, not Level-I proven; over-aggressive motion risks re-subluxation in a marginally stable repair.
  2. Brace necessity & utility. A hinged orthosis is the published standard, but Manocha/King (JHS 2018) showed it adds little stability with the arm overhead (gravity already compresses the joint), supporting overhead/supine rehab over brace reliance for lateral injuries (Lee 2013). This underpins Dr Hirpara's no-external-brace approach.
  3. Forearm-rotation dogma. Pronation-for-lateral / supination-for-medial is biomechanically grounded and widely taught, but Selley 2025 found forearm rotation at graft tensioning did not change postoperative medial gapping — questioning how rigidly rotation must be controlled in UCL cases.
  4. Accelerated vs conservative UCL return-to-throw. Time-to-RTS varies 4–16 months with no consensus threshold; Erickson 2017 found earlier RTS did not raise revision risk in MLB pitchers, undercutting strict "wait ≥12 months" dogma.
  5. Internal brace enabling faster rehab. The biggest recent shift: suture-tape/internal-brace augmentation gives superior time-zero biomechanics and supports repair (not reconstruction) in selected throwers with a 5–9-week-faster throwing timeline. Durability in elite pitchers and mid-substance tears is still maturing (Level III–IV).

Evidence strength flags

  • (A) Complex instability / LCL: LOW–MODERATE. No RCTs; guidance is biomechanical + expert-consensus + Level III/IV case series and two 2024 systematic reviews. Internal-joint-stabiliser data (Orbay/Mighell lineage; Dunning/Morrey biomechanics) are device-specific case series — Consensus / Moderate.
  • (B) UCL throwing: MODERATE. Large case series, multiple systematic reviews, and concordant institution-standard protocols (Brigham/Brotzman-Wilk, Mass General, ASMI/Andrews) for the phased arc and interval-throwing timeline. Internal-brace augmentation is newer (Level III–IV, growing).
  • Rehabilitation protocols themselves: CONSENSUS / WEAK — phase timings derive from published institutional protocols, not rehab RCTs.

Citations

RAG corpus (180,000+ Orthopaedic articles)

  • Szekeres M, Chinchalkar SJ, King GJ. Optimizing Elbow Rehabilitation After Instability. Hand Clin. 2008.
  • Wilk KE, Arrigo CA. Rehabilitation of Elbow Injuries. Clin Sports Med. 2020.
  • Ahmed Kamel S, Shepherd J, Al-Shahwani A, et al. Postoperative mobilization after terrible triad injury: systematic review and single-arm meta-analysis. J Shoulder Elbow Surg. 2024;33(3):e116–e125.
  • Larwa J, Buchanan TR, Janke RL, et al. Characteristics of rehabilitation protocols following operative treatment of terrible triad elbow injuries and the influence of early motion: systematic review and meta-analysis. Shoulder Elbow. 2024.
  • Najd Mazhar F, Jafari D, Mirzaei A. Evaluation of functional outcome after nonsurgical management of terrible triad injuries of the elbow. J Shoulder Elbow Surg. 2017;26(8):1342–1347.
  • Manocha RH, King GJ, Johnson JA. In Vitro Kinematic Assessment of a Hinged Elbow Orthosis Following Lateral Collateral Ligament Injury. J Hand Surg Am. 2018.
  • Lee AT, Schrumpf MA, Choi D, et al. The influence of gravity on the unstable elbow. J Shoulder Elbow Surg. 2013;22(1).
  • Dunning CE, et al. (Morrey lineage). Ligamentous Repair and Reconstruction for Posterolateral Rotatory Instability of the Elbow. 2006. (LCL/LUCL stabiliser biomechanics.)
  • Müller AM, Sadoghi P, Lucas R, et al. Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: systematic review/meta-analysis of 13 studies. J Shoulder Elbow Surg. 2013. (Static-progressive stretch for stiffness.)
  • Selley RS, Lawton CD, Owusu-Akyaw K, et al. Forearm Rotation at the Time of Elbow UCL Reconstruction Graft Tensioning Does Not Affect Postoperative Medial Elbow Joint Gapping. Orthop J Sports Med. 2025.
  • Erickson BJ, Cvetanovich GL, Frank RM, et al. Do Clinical Results and RTS Rates After UCL Reconstruction Differ Based on Graft Choice and Surgical Technique? Orthop J Sports Med. 2016.
  • Erickson BJ, Chalmers PN, Bach BR, et al. Length of time between surgery and RTS after UCL reconstruction in MLB pitchers does not predict need for revision. J Shoulder Elbow Surg. 2017.
  • Kemler BR, Rao S, Willier DP, et al. Rehabilitation and Return to Sport Criteria Following UCL Reconstruction: A Systematic Review. Am J Sports Med. 2021.
  • Griffith R, Bolia IK, Fretes N, et al. RTS Criteria After Upper Extremity Surgery, Part 2: UCL of the Elbow. Orthop J Sports Med. 2021.
  • Dugas JR, Froom RJ, Mussell EA, et al. Clinical Outcomes of UCL Repair With Internal Brace Versus UCL Reconstruction in Competitive Athletes. Am J Sports Med. 2025.
  • Dugas JR, Looze CA, Capogna B, et al. UCL Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes. Am J Sports Med. 2019;47(5).
  • Jackson GR, Opara O, Tuthill T, et al. Suture Augmentation in Orthopaedic Surgery Offers Improved Time-Zero Biomechanics and Promising Short-Term Clinical Outcomes. Arthroscopy. 2023.
  • Cain EL, Dugas JR, Wolf RS, et al. Elbow Injuries in Throwing Athletes: A Current Concepts Review. Am J Sports Med. 2003.
  • Erickson BJ, Bach BR, Verma NN, et al. Treatment of Ulnar Collateral Ligament Tears of the Elbow. Orthop J Sports Med. 2017.
  • Rockwood and Green's Fractures in Adults. 2019. — long-arm splint 7–10 d; lateral injury → forearm pronated, medial → supinated; avoid shoulder abduction/varus for lateral injury; strengthening ~6 wk.
  • Green's Operative Hand Surgery. 2021. — supination only with elbow maximally flexed; overhead/supine protocol option; isometric strengthening 8–10 wk; unrestricted use ≥6 mo.

Published protocols (literature URLs)

  • Brigham & Women's Hospital — Elbow Fracture/Dislocation Post-Op ORIF Hand Therapy Guideline (2021). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-fracture-orif-hand-therapy-protocol.pdf
  • Brigham & Women's Hospital — UCL of the Elbow Reconstruction Using Autogenous Graft Protocol (Brotzman-Wilk modification). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-ulnar-collateral-ligament-reconstruction-protocol-bwh.pdf
  • Massachusetts General Hospital Sports Medicine — Rehabilitation Protocol for UCL Reconstruction (rev. Nov 2018). https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-UCL.pdf
  • Saint Louis University Sports Medicine / JOSPT 2019 — Rehabilitation s/p UCL Repair with Internal Brace. https://www.slu.edu/medicine/orthopaedic-surgery/sports-medicine/-pdf/ucl-repair-guidelines-final.pdf
  • Eichinger MD — Rehabilitation Guidelines for Elbow Lateral Collateral Ligament Repair (2018). https://www.josefeichingermd.com/pdf/rehab-for-lateral-collateral-ligament-repair-3-4-18.pdf
  • Denver Shoulder — Rehabilitation Protocol: Lateral Collateral Ligament Repair (extension block 30°→20°→10°→0° wk2–5, forearm pronated; supination only at 90° flexion). https://www.denvershouldersurgeon.com/pdf/lcl-repair-protocol.pdf
  • Orthopaedic Medical Group of Tampa Bay — Elbow Dislocation Rehab Protocol. https://www.omgtb.com/wp-content/uploads/pdfs/elbow-dislocation-rehab.pdf

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.