Sling When will I go home? What can I do? What can’t I do?
4 weeks You will be discharged on the day after the operation Gentle range of movement No active movements, no lifting

Acute phase (0-6 weeks)

Goals

  • Reduce pain
  • Keep arm in a comfortable yet functional position
  • Wrist and finger mobilization

Rehabilitation

  • Out of sling/elbow splint as tolerated
  • Patient education regarding proper positioning, range of movement precautions, joint protection techniques
  • No lifting of objects greater than 1 kilogram with operated upper extremity
  • No excessive stretching or sudden movements (particularly extension)
  • No forced flexion
  • Avoid varus/valgus stress to the elbow
  • No upper extremity weight bearing with the involved side
  • Gentle active assisted range of movement elbow extension and flexion exercises initiated with elbow held close to the body (adducted position) with forearm in neutral to pronation bias
  • Unless otherwise instructed, forearm rotations are to be completed with the elbow held at the side at 90 degrees of flexion to minimize strain on ligamentous structures
  • Assisted range of movement of cervical spine, shoulder, wrist, and hand
  • Gentle gravity-assisted elbow extension range o movement stretching
  • Frequent cryotherapy for pain, swelling, and inflammation management
  • Compressive wrapping/garments for oedema management as indicated

Criteria for progression

  • Pain control

Intermediate phase (6-12 weeks)

Goals

  • Encourage functional range of movement and strength of the elbow for activities of daily living, while protecting healing soft tissues
  • Minimize pain and inflammation
  • Re-establish dynamic elbow stability & proprioception

Rehabilitation

  • 6 weeks postop: begin submaximal painfree elbow/forearm/wrist/hand isometrics at mid range of available elbow range of motion (all planes)
  • 8 weeks postop: progress to submaximal painfree elbow/forearm/ wrist/hand isometrics at multiple angles of available elbow range of motion. However, no isometrics at end ranges of motion
  • 10-12 weeks postop: progress to sub maximal pain free shoulder and elbow/wrist/hand isotonic strengthening as motor control improves
  • Initially single plane elbow movement then progress to composite movements as appropriate
  • If patient has not achieved functional elbow range of motion of at least 120 degrees flexion then consider the use of a dynamic or static progressive splint
  • Continue use of cryotherapy and oedema management for pain and inflammation

Criteria for progression

  • Pain free range of movement

Late phase (>12 weeks)

Goals

  • Restore full range of movement

Rehabilitation

  • Maintain a home program with focus on pain free functional arc of elbow motion, strength and proprioception
  • Continue previous exercises 2-3 times a week to maintain range of movement, strength, and function upon discharge from physiotherapy
  • No heavy lifting of objects (no heavier than 5kg) for life
  • No tennis or throwing activities for life

Guidelines for return to functional activities

Driving

Lifting

Swimming

Golf

3 months No more than 5kg for life 3 months 4 months

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