Post-operative rehabilitation (developed in conjunction with Nick Antoniou Hand Therapy)

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Goals:

1. Protect healing structures (LUCL)

2. Prevent subluxation of radial head/elbow joint

3. Decrease pain and inflammation

4. Restore elbow ROM in protected position during healing phase

5. Restore posterolateral elbow stability

 

Evaluation

1. Wound

2. Oedema

3. AROM – in overhead (supine) position

4. Impact of any other concomitant or associated injuries

 

Initial Phase (0-4 weeks)

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Initial appointment (10-14 days post-operatively)

• Remove post-operative dressing and primary dressing of wound

• Apply tubigrip (or similar) to elbow to reduce post-operative swelling

• Commence scar management if suitable

• Fashion posterior shell elbow splint

  • splint at 120 deg of flexion to approximate radial head to coronoid process​

  • forearm pronation to minimise lateral stress

  • wrist in neutral flexion/extension

  • splint all time except for hygiene and overhead exercises exercises 

• Commence overhead elbow protocol in supine position:

  • shoulder flexed to 90 deg, adducted, and in neutral to slightly externally rotated position

    • ​This position minimizes the effect of gravity, decreases posteriorly directed forces, and allows the triceps to function as an elbow stabilizer. By avoiding abduction and internal rotation, the gravitational varus force is eliminated thereby allowing the lateral collateral ligament to heal in an isometric fashion.

  • With the arm in above position, following exercises are performed: 

    • Active assisted forearm pronation and supination, with elbow in 90 deg flexion​

    • Active assisted elbow flexion with no limit

    • Active/active-assisted elbow extension, limited to 30 deg short of full extension

• Elbow Varus Precautions (for first 6 weeks)

  • avoid shoulder abduction and internal rotation

  • avoid full elbow extension, especially combined with forearm supination

  • when sleeping a pillow is placed between the affected arm and torso (when lying on back) or several pillows placed under elbow when side lying (on opposite side)

• if excessive pain or unexpected stiffness in motion – suggest xrays to check for subluxation of joint

 

Intermediate Phase (4-6 weeks post-operatively)

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• Remold posterior splint to 90 deg of elbow flexion at 4 weeks, and forearm now in neutral rotation rather than pronation

• Continue supine overhead exercises as above

• Shoulder internal rotation is still avoided to minimize gravitational varus strain

 

Advanced Phase (6+ weeks post-operatively)

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• Wean out of splint

• Start all seated range of motion exercises, capsular stretching

• Increase strength and endurance​

• Commence gradual weightbearing exercises

• Static progressive splinting if needed after 8 weeks

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