Let me say this first: I will absolutely try to shorten this post down as much as I can, while still providing valuable content/education. This topic can be a long one when you start breaking down the who/what/where/when and the impact of the ulnar nerve. I will try to keep it to the most predominant information as it pertains to baseball/softball players and overhead athletes, in general.
With that being said, lets get started!
What is the ulnar nerve?
The ulnar nerve is a nerve that runs the length of your arm, from neck to shoulder down to your hand (pinky and 1/2 of the ring finger). Most people know this nerve by the term "funny bone." It's that tingling sensation you get when you bang your elbow into/onto something.
What does the ulnar nerve do?
The ulnar nerve provides sensation to your forearm, the pinky, and half of the ring finger. It also innervates the flexor muscles of the hand/wrist, which allows you to bend them up.
Now. Let me skip ahead some. Chances are, if you're reading this, you already know what ulnar nerve trans-positioning is, otherwise you probably wouldn't have made it this far. If you do not know what this procedure is, or does, I'll give you the short and sweet version.
Overhead athletes often have this procedure when their ulnar nerve has trouble staying in the groove at their elbow, especially when performing repetitive overhead activity (throwing). When this nerve "slips" in and out of this groove, it can be very painful and provides a great deal of discomfort. If you want to find out more, you can look it up or ask me for more details.
Alright, next let's continue on with what a rehab timeline/protocol might look like.
I've talked about this with some of my colleagues and coworkers and we've come up with some general guidelines post-op.
(NOTE: ALL OF THESE ARE JUST GUIDELINES FOR A SUCCESSFUL RECOVERY AND ARE ASSUMING A TYPICAL TRANSPOSITIONING PROCEDURE. IF YOU'RE SURGEON HAS SPECIFIC INSTRUCTIONS THAT HE/SHE WANTS YOU TO FOLLOW, THEN ABSOLUTELY FOLLOW THEIR PROTOCOL. THIS IS MEANT TO BE EDUCATIONAL AND IN NO WAY SHOULD REPLACE YOUR MD'S PROTOCOL.)
Post-op Week 1:
Right away, we would like to start you on some low level gripping exercises to get some blood flow going through the arm/hand and to help reduce any muscle atrophy (or weakening of the muscles) that you are most certainly going to get throughout the forearm. The more we can activate these forearm muscle groups and intrinsics through the hand/fingers, the quicker you can return to your previous levels. The main things we like to see here are decreasing pain while also trying to control your swelling.
Some surgeons will also allow for shoulder isometric exercises at this stage to help reduce the atrophy of the rotator cuff and scapular stabilizers.
Week 2:
This is where a good skilled clinician, PT, PTA, ATC, OT, COTA can come into play. We like to work on your passive range of motion here, which is when we get to stretch your elbow while you just relax. Many people struggle relaxing enough to allow the clinician to stretch their elbow; the key is trusting your clinician and understanding that they are not going to hurt you (if they ARE hurting you/your elbow, you should tell them!).
Understand that just because we are starting to stretch your elbow, doesn't mean that you should have full range back yet. The surgery is still very fresh and this will take a little time to get all the way back. Your tolerance to the stretching is what tells us how far we can straighten/bend your elbow.
Week 3:
This is when things start to get a little more fun (for us and for you). We get to start being a little more aggressive, within your tolerance, obviously.
But before that, we want to make sure your range is full or very close to full motion. When we reach that point, you can begin doing more wrist/elbow/shoulder strengthening exercises and more stability work.
Week 4:
Hopefully by week 4, or shortly thereafter, your elbow range of motion has returned to it's prior level, or equal to the opposite arm. This allows us to do more strengthening exercises and challenge the endurance of your muscles in the shoulder and forearm.
Basically, from week four through week eight, we are doing as much strengthening and endurance building to allow you to return to throwing.
Week 8:
You're now two months post-surgery. If things have been going to plan, your elbow range of motion is full and the strengthening exercises we've been doing have not increased your elbow pain. Your swelling is down and you've returned to all of your "normal" activities, such as writing, brushing your hair/teeth, etc.
It's typically somewhere along this next month (four weeks) that we ease you back into sport activity/throwing. It's important to continue with the strengthening exercises we've been doing up to this point, as well as maintaining your range of motion. It's not uncommon for athletes to lose a little motion when they start challenging the elbow again with higher intensity weight training.
Some surgeons will allow the baseball/softball player to begin swinging again at this stage (week eight).
Make sure when you are allowed to begin throwing again (typically between weeks eight and twelve), that you're working with someone that understands the mechanics of the throw and can help provide feedback (including visual, auditory, and tactile).
Week 12:
Again, we'll assume that everything has gone well. No setbacks along the way, pain was kept under control, and swelling limited. This is when you can return to competition.
This next phrase I cannot stress enough:
Even when you are cleared to return to sport/games, you MUST continue to work on the strengthening and stretching exercises that you've been doing over the past 4-6 weeks! Failure to do so can lead to re-injury or increasing your chances for another injury somewhere along the chain.
I see it all too often. Athletes are released by their MD to return to sport, and they think it's OK to stop working on the strengthening and stretching exercises that we've been working on the past 1, 2, or even 3 months. Then, usually within 3-6 months (or less), we see that same athlete again with the same injury or one relating to it because they didn't keep up with their exercises.
Before I wrap this up, I want to remind everyone of an important note along this rehab process.
Just because we are talking about the elbow and the rehab guidelines for this recovery, don't forget about the your core and gluteal muscle groups. This is something that you can start immediately following surgery. Maintain and even increase your core/glute muscle strength and endurance from day one. There will be a lot of things that you cannot do or are not allowed to do. But strengthening these muscles is 100% acceptable and should be an important part of your overall rehab process.
Make it your goal to come back better than before. Strive to reach levels that you previously did not or could not. Set higher standards for yourself.
Have a plan, put it to action, and let everything else fall into place.
Good luck and thanks for reading!
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