UCL Direct repair of 15 year old

My 15 year old son is 3 months recovered from a direct repair of his UCL with a suture anchor. It was fully torn off the bone at the fracture of his medial epicondyle which they also repaired that with a screw. He’s had 3 months of PT for range of motion and general strength legs, core, forearm grip and shoulders. He has had no pain since the surgery beside the scar irritating him for a few weeks. Starting with a pitching PT this week and doc says he can start throwing end of December and throwing 100% by March… He was moving up the ladder throwing 84-85 when he was injured. With all the Covid stuff ,his sophomore HS School season got pushed back so he will have extra time for recovery. I’m looking for someone who has gone through the direct repair and any feedback on how quickly you returned to play and at what level. Doc says with my son being young his chances are good to come back at the same level.

Baseball17,

“My 15 year old son is 3 months recovered from a direct repair of his UCL with a suture anchor. It was fully torn off the bone at the fracture of his medial epicondyle which they also repaired that with a screw.”

Did the Dr. tell you if his Elbow was fully developed (fused growth plates) at the time of the injury?

In equated biological maturers (Chronological age matches the biological age) The Elbow completes it’s solidification process at 16 yo. There would have had to have been opposite elbow x-rays to know.

Hopefully he was an advanced maturer and his Elbows were already fused. This makes the difference when continuing with avulsions (ligament or Tendon separated from bone bed)

“He’s had 3 months of PT for range of motion and general strength legs, core, forearm grip and shoulders.”

General fitness is a good start.

He should learn why he overstressed the MCL (UCL) and mitigate that mechanic when he starts to interval train “sport specifically” again.

“He has had no pain since the surgery beside the scar irritating him for a few weeks.”

This is good. That is the only place pain receptors exist in that area at the bone bed in the bone. Ligaments have no pain receptors and he will not know if he is over stressing it.

Will they at some point remove the screw?

“Starting with a pitching PT this week and doc says he can start throwing end of December and throwing 100% by March…”

We start throwing 10 weeks after surgery with normal ruptures after surgery. Dr’s release normally comes at 9 weeks. You have the avulsion to deal with, take your time but it sounds like he’s ready at 3 mo. post.

“He was moving up the ladder throwing 84-85 when he was injured.”

Have you been told why it occurred?

Have you been asked to mitigate the pathomechanic that caused it?

Ask your private instructor if he has any idea how we are not going to repeat this.

This is the cause.

When his front foot plants and stabilizes he start his first forwards acceleration through body rotation. If the Humerus is not fully outwardly rotated, it is then late in this action and must transition outwardly to catch up. This bounce back causes over Valgus stress on the MCL, micro fraying it with every pitch. Because he intuitively powers the ball in forearm supination, he is contracting the supinators that pull the Radius away from the Ulna and not supporting the MCL at the start of acceleration. This is all from being late with Humeral/forearm outwards rotation from the pendulum swing timing with forearm pronation going back. You will see his hand on top of the ball at the back.

Mitigation:

He must learn all forearm pronated pitch types and how to arrive his Humeral/forearm transition full outwards rotation in sync with glove side foot plant. This is done by pendulum swinging the arm down then back then up to driveline height (top of head level) by forearm supinating on the way back so that when he turns on the power the Pronators take over and pull the Radius towards the Ulna in the same direction of the Humerus both inwardly rotating, minimal MCL stress. Now he can actually overload train “sport specifically” where the MCL is not in play.

“With all the Covid stuff ,his sophomore HS School season got pushed back so he will have extra time for recovery.”

This is actually a chance for this age group to improve correctly through more controlled training intervals practice and less competitions, hopefully no competitions until spring.

With our sport specific training program and mechanical corrections to withstand the overload stress we use, it takes 9 mo. from surgery to competition to restart and much more specifically fit than when he stopped.

“I’m looking for someone who has gone through the direct repair and any feedback on how quickly you returned to play and at what level.”

All your resources should be towards mitigation of previous force application during recovery.

Please read the meritorious info at Drmikemarshall.com, don’t worry about the radicalized bottom half info, nobody is ready for that improvement yet.