Protocol must be altered based on fixation strength at surgery and surgeon preference.
Goal: Regain full pain-free ROM of elbow and prevent shoulder and wrist stiffness.
Phase I (0 to 7 days)
Hand and Finger ROM.
Plaster to immobilise elbow until wound review.
Phase II (7 to 14 days)
Elbow active and active-assisted flexion. Passive extension. Goal is 15° to 105° of motion by 14 days. ROM should be performed with the arm adducted close to the body.
Putty/grip exercises.
Isometric strengthening exercises for the elbow and wrist.
Phase III (15 days to 6 weeks)
Continue elbow active and active assisted flexion exercises. Passive extension.
Full flexion and extension ROM should be achieved by the end of 6 weeks.
Begin light isotonic strengthening of flexion.
Maintain shoulder, wrist, hand strength and ROM.
Phase IV (7-12 weeks)
Begin active and active assisted supination and pronation.
Full pronation and supination should be achieved by the end of the 8th week.
Progressively increase isotonic strengthening in flexion.
Begin active extension and extension strengthening once bony union is evident on xrays / indicated by Dr Watson.
