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