Nathan WM. Skelley, M.D.

Phase I (2 – 4 weeks)

Appointments

• Home exercise program will begin after surgery – 2 weeks

• 1-3x/wk. from 2-6 wks.

Rehabilitation Goals

• Improve range of motion

• Decrease pain and inflammation

• Maintain strength/establish motor control

Precautions

• Remain immobilized for first 2 weeks

• Hinged elbow brace weeks 2-6

• Avoid excessive shoulder extension

• Avoid full elbow extension until 3 weeks

• No forceful elbow extension

Range of Motion

Weeks 2-3
• Brace unlocked at 30 degrees to full flexion

Weeks 3-4
• Brace unlocked to full extension to full flexion

Suggested Therapeutic Exercise

Weeks 2-3

• Passive range of motion of elbow flexion and supination (elbow at 90 degrees)

• Assisted Range of motion for elbow extension and pronation (elbow at 90 degrees)

• Shoulder range of motion as needed, avoid excessive extension

• Sub maximal pain free isometrics for triceps and shoulder

  musculature

• Submaximal pain free biceps isometrics with forearm in

  neutral Weeks 3-4

• Initiate active assisted range of motion elbow flexion

• Continue assisted extension and progress to passive range of

  motion

• Single plane active range of motion elbow flexion, extension,

  supination, and pronation

Cardiovascular exercise

• Walking, stationary bike in brace

Progression Criteria

• Full active ROM flexion and extension

• No swelling or inflammation

 

Phase II (weeks 4-8)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

• Improve range of motion to full

• Maintain/improve strength

Precautions

• Avoid forceful elbow and shoulder extension

Suggested Therapeutic Exercise

Week 4

• Active Range of motion elbow flexion and extension

• Single plane active range of motion elbow flexion, extension,

  supination, and pronation Week 6-8

• Continue as above

• May begin combined/composite motions

• If at 8 weeks postoperative the patient has significant range of

  motion deficits therapist may consider more aggressive management, after consultation with referring surgeon to regain range of motion

• Progressive resisted exercise program is initiated for elbow flexion, extension, supination, and pronation

Cardiovascular Exercise

• Walking, biking, stair stepper and running (if cleared)

Progression criteria

• Full range of motion

• No pain, swelling, or inflammation

 

Phase III (weeks 8-12)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

• Continue to improve strength and function

• Return to activity as tolerated

• Improve endurance

Precautions

• Progress gradually into proactive exercises by beginning with low velocity, known movement patterns

Suggested Therapeutic exercises

• Continue all activities as above

• May initiate light upper extremity weight training program

• Initiate endurance program that stimulates desired

  work/activity requirements

Cardiovascular exercise

• Replicate sport or work specific energy demands

Progression Criteria

• Dynamic neuromuscular control with multi-plane activities without pain or swelling

 

Phase IV (Weeks 13- 24)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

• Return to sport/work

Precautions

• Progress gradually into sport specific demands

Suggested Therapeutic exercises

• Continue/progress strengthening exercises

• Activity as tolerated is permitted

• Begin sport specific training

Cardiovascular exercise

• Replicate sport or work specific energy demands

Progression Criteria

• Dynamic neuromuscular control with multi-plane activities without pain or swelling