Note: This pathway is designed to serve as a guide to rehabilitation. Indications for progression should be based on patient’s complete operative procedure, functional capacity and response to treatment.

Post-Operative Elbow Immobilization

  • Posterior splint with elbow immobilized at 90° for 1-2 weeks, which is not to be removed

Hinged Elbow Brace

  • If no hinged brace was prescribed, limit extension and supination ROM to patient’s pain tolerance
  • Elbow placed in hinged brace between 35° and 135°, but may vary at the discretion of the surgeon.
  • Brace extension ROM is decreased to 20°, 10°, and 0° in weeks 3,4,5 respectively and worn for 7 weeks post-op.
  • Only take the brace off for showering and exercise.

Phase 1 | Weeks 1 to 3

Goals by week 3:

  • Elbow ROM 35-135°
  • Full pronation and supination ROM
  • Minimize swelling

Precautions:

  • No active elbow flexion or lifting
  • No aggressive elbow extension stretching, just passive extension ROM to patient tolerance
  • No sudden and/or sharp movements

Therapeutic Exercise:

  • Brace is removed to perform exercises
  • PROM for elbow flexion and supination (with elbow at 90°) to patient tolerance
  • AAROM for elbow extension and pronation (with elbow at 90°) to patient tolerance
  • Shoulder, wrist and hand AROM, avoiding excessive shoulder extension
  • Modalities to minimize inflammation and control pain

Phase 2 | Weeks 4 to 8

Goals by week 8:

  • Full elbow and forearm AROM
  • Scar management

Therapeutic Exercise:

  • AAROM elbow flexion, progressing to AROM
  • No aggressive elbow extension stretching
  • Scar mobilization
  • Grip strengthening
  • Pulleys, UBE
  • Progress to gentle strengthening at 6 weeks
  • Shoulder/scapular stabilization
  • Elbow joint mobilization

Phase 3 | After week 8

  • If ROM restrictions persist, begin more aggressive stretching
  • Progress strengthening gradually in all directions after week 8
  • Return to mostly unrestricted activity at 4 months. Unrestricted intensity of biceps curls may resume between 4 and 6 months at surgeon’s discretion.