Phase I: Protection and Early Motion (0–2 Weeks)

Immobilisation:

• Arm supported in a sling for comfort when not exercising

• Begin active mobilisation within 24–48 hours

Precautions:

• Avoid prolonged immobilisation

• No lifting, pushing, or weight bearing

• Monitor for neurovascular changes (especially ulnar nerve symptoms)

• Avoid aggressive stretching early on

Therapy:

• Pain-controlled passive and active-assisted ROM within comfort limits

• Emphasise extension and flexion recovery

• Elbow flexion and extension in gravity-minimised positions

• Begin gentle pronation/supination active ROM

• Rest, ice, compress and elevate (RICE) for pain and inflammation.

Criteria to Progress:

• Active elbow ROM initiation

• Pain controlled

• Wound healing intact

Phase II: Controlled Motion and Soft Tissue Recovery (2–6 Weeks)

Immobilisation:

• Discontinue sling

Precautions:

• Avoid passive overpressure or forced stretching

• No resisted elbow loading

• Protect ulnar nerve if transposed

Therapy:

• Active and active-assisted exercises in all planes

• Begin isometric strengthening for shoulder, wrist, and elbow

• Scar tissue mobilisation if applicable

• Joint mobilisation (grade I–II) if tolerated

• Monitor and address emerging nerve symptoms

Criteria to Progress:

• Elbow flexion >100° and extension <30°

• Tolerating strengthening and motion drills

• Minimal pain with movement

Phase III: Strength and Functional Recovery (6–12 Weeks)

Precautions:

• Avoid sudden or forceful elbow loading

• Progressively load, respecting tissue healing time

Therapy:

• Full elbow ROM goal: 0°–140°

• Begin isotonic resistance training for elbow flexors/extensors

• Proprioceptive and neuromuscular control drills

• Functional tasks incorporating elbow use

• Begin light activity simulations

Criteria to Progress:

• Full pain-free ROM

• Strength ≥80% of contralateral side

• No instability or discomfort

Phase IV: Advanced Strengthening & Functional Return (3–6 Months)

Therapy:

• Progressive resistance and endurance training

• Sport- or job-specific functional training

• Plyometrics and reactive drills if needed

• Continue flexibility and mobility maintenance

Criteria to Discharge:

• Full ROM and strength

• Independent self-care and work-specific activity

• Surgeon clearance

General Recommendations

Work:

• Office/desk work may resume after 2–4 weeks if pain is well controlled

• Manual labour should be deferred until 6–12 weeks depending on job demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light upper limb activities may resume from approximately 2–4 weeks.

• Progressive return to gym and functional activities from 4–6 weeks.

• Higher-demand activities may resume from 6–8 weeks as motion and strength improve.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.