Nathan WM. Skelley, M.D.

PHASE I - Initial Phase (Week 1)

Goal: Full wrist and elbow ROM, decrease swelling, decrease pain, stop muscle atrophy

A. Day of Surgery
Begin gently moving elbow in bulky dressing

B. Post-op Day 1 and 2
1. Immediate post-op hand, wrist, and elbow exercises

a. Putty/grip strengthening

b. Wrist flexor stretching
c. Wrist extensor stretching

d. Wrist curls

e. Reverse wrist curls
f. Neutral wrist curls
g. Pronation/supination

h. AAROM elbow ext/flex

C. Post-op Day 3 through 7
1. PROM elbow ext/flex (motion to tolerance)
2. Begin Progressive Resistance Exercises (PRE) with 1 lb weight

a. Wrist curls
b. Reverse wrist curls
c. Neutral wrist curls
d. Pronation/supination

e. Broomstick roll-up

 

PHASE II - Intermediate Phase (Week 2-4)

Goal: Improve muscular strength and endurance; normalize joint arthrokinematics

A. Week 2 Range of Motion exercises (overpressure into extension)

1. Addition of biceps curls and triceps extension
2. Continue to progress PRE weight and repetitions as tolerable

B. Week 3
1. Initiate biceps and biceps eccentric exercise program

2. Initiate rotator cuff exercises program

a. External rotators

b. Internal rotators

c. Deltoid
d. Supraspinatus

e. Scapulothoracic strengthening

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PHASE III - Advanced Phase (Week 4-8)

Goals: Preparation of athlete for return to functional activities

*Criteria to progress to Advanced Phase:
1. Full non-painful ROM
2. No pain or tenderness
3. Isokinetic test that fulfills criteria to throw

4. Satisfactory clinical exam

A. Weeks 4 through 6
1. Continue maintenance program, emphasizing muscular strength, endurance, & flexibility

2. Initiate Interval Throwing Program Phase