Chapter 14: Upper Extremity: The Hand, Wrist, and Elbow

ATHLETIC TRAINER'S CORNER

Here is what one athletic trainer experienced with a real world athlete's rehabilitation from injury:

One of the starting pitchers on our championship Division I baseball team underwent Tommy John surgery. Tommy John surgery is a surgical procedure to reconstruct the ulnar collateral ligament (UCL) using a tendon from the forearm. The tendon is used to recreate the damaged ligament and improve the elbow joint's stability. The player was a multisport athlete who had been competing since a young age. Because of a previous shoulder injury during high school football, his pitching mechanics were altered, thus causing more stress on his elbow. Over time and because of the repetitive motion of pitching, the amount of pitches that he threw per week decreased drastically, and he began experiencing numbness and paraesthesia radiating down his forearm and into his little finger. The player never told anyone about his pain, but it soon became evident that his performance and throwing velocity were decreasing. During a game one Friday night, one pitch practically landed at a vertical angle straight into the ground after he felt a pop in his elbow. Magnetic resonance image (MRI) confirmed a UCL tear, which led to surgery and 10 months of rehabilitation for the player. The player's typical rehabilitation day consisted of ROM exercises, followed by strengthening, and ended with ice therapy before being placed back into a functional elbow brace. I learned quickly to always place a barrier over the ulnar nerve to eliminate numbness in the little finger when using ice.

The player began a throwing program around the fourth month and then graduated to pitching off the mound around the sixth month. In this particular athlete's case, he never fully recovered from this injury. Although he felt great, and competed the next season, his pitching career was never the same. I learned that successful recovery following Tommy John surgery is dependent on ROM, time, direct observation, and outside factors. I believe that one of the most important immediate postoperative goals for these athletes is the reestablishment of ROM. Recovery can easily take up to 1 year, and the time may be shorter in some instances. Getting the athlete active as soon as possible is critical to helping him or her maintain a positive outlook during the rehabilitation process. One tool that helps the athlete is to mark a calendar with a start date (date of surgery) and a target completion date (generally 9 months later). Next, write down each day's activity so that the athlete has something to refer to when he or she has questions regarding progress. The calendar allows the athlete to see progress and to focus on the end goal that keeps motivation levels high.

J. R. Honisch, AT, ATC

OrthoIndy

Indianapolis, Indiana

LEARNING OUTCOMES