Doctor checking patient with elbow to determine the cause of illness.

ORIF Medial Epicondyle Rehab Protocol

Phase I –Immediate Post Operative Phase

• Week 1 

o Posterior splint at 90° elbow flexion for 7 days 

o Brace: application of functional brace set at 30-100° at day 7-10 after splint removed o ROM: wrist AROM ext/flexion o Elbow compression dressing 2-3 days 

o Exercises § Gripping & Wrist ROM (passive only) & Shoulder isometrics (no shoulder ER) & Biceps isometrics & Cryotherapy

• Week 2 

o Brace: Elbow ROM 25-100° in brace & Gradually increase ROM 5° ext and 10° of flexion per week 

o Exercises § Continue all exercises listed above § Elbow ROM in brace § Initiate elbow extension isometrics 

• Week 3 

o Brace: Elbow ROM 15-110° 

o Exercises & Continue all exercises listed above & Elbow ROM in brace & Initiate active ROM wrist and elbow (no resistance)

Phase II –Intermediate Phase (Week 4-7) 

• Goals 

o Gradual increase to full ROM 

o Promote healing of repaired tissue 

o Regain and improve muscular strength 

• Week 4 o Brace: elbow ROM 0-125

o Exercises & Begin light resistance exercises or arm (1 lbs) & Wrist curls, extensions, pronation, supination & Elbow ext/flexion 

o Progress shoulder program to emphasize rotator cuff strengthening & Avoid external rotation until week 6

• Week 5 

o ROM: elbow ROM 0-135° 

o Discontinue brace 

o Continue all exercises

 • Week 6 

o ROM: 0-145° without brace or full ROM 

o Exercises & Progress elbow strengthening exercises & Initiate shoulder external rotation strengthening 

• Week 7 

o Progress light isotonic program 

Phase III –Advanced Strengthening Program (Week 8-13) 

• Goals 

o Improve strength/power/endurance 

o Maintain full elbow ROM 

o Gradual return to functional activities

 • Week 8-10 

o Exercises & Initiate eccentric elbow flexion/extension & Continue 

• Isotonic program –forearm and wrist 

• Stretching program –especially elbow extension 

• Week 11-13 

o Exercises & Continue all exercises listed above & Initiate plyometric exercise program 

Phase IV –Return to Activity (week 14-32) 

• Goals 

o Continue to increase strength, power, and endurance of upper extremity musculature 

o Gradual return to activities 

• Week 14 

o Exercises: continue strengthening program & Emphasis on elbow and wrist strengthening and flexibility exercises & Maintain full elbow ROM

• Week 16 

o Exercises & Initiate interval throwing program

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