Elbow Replacement Rehab

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