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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