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

Immobilisation:

• Arm supported in a standard sling at all times (including during sleep)

• In selected cases, repair/reconstruction supported by a backslap for the first 2 weeks

Precautions:

• No valgus stress to the elbow.

• Avoid lifting, pushing, pulling, or weight bearing through the operated arm.

• Avoid forceful end-range elbow extension.

Therapy:

• Gentle passive and active-assisted elbow flexion and extension within comfort and brace limits if applicable.

• Forearm pronation and supination with the elbow flexed.

• Hand, wrist, and shoulder range of motion exercises.

• Oedema control and pain management.

Criteria to Progress:

• Pain and swelling controlled.

• Tolerating elbow motion without increased symptoms.

Phase II: Controlled Motion Phase (2–6 Weeks)

Immobilisation:

• Sling use gradually weaned beginning week 2; discontinue by end of week 6

• In selected cases, repair/reconstruction supported with a hinged elbow brace, locked at 30° short of full extension with full flexion, until end of Week 6.

Precautions:

• Avoid valgus loading and resisted throwing-type activities.

• Avoid lifting heavier than light household items.

Therapy:

• Progress passive and active-assisted elbow range of motion to flexion and extension within 30° short of full extension with full flexion.

• Continue forearm rotation with elbow flexed.

• Gentle shoulder and scapular range of motion exercises.

Criteria to Progress:

• Improving elbow range of motion.

• Pain minimal during daily activities.

Phase III: Strengthening Phase (6–12 Weeks)

Immobilisation:

• Sling discontinued.

• Hinged elbow brace discontinued if used.

Precautions:

• Avoid high-velocity valgus stress.

• Avoid heavy lifting.

Therapy:

• Progress to full active elbow range of motion.

• Begin gentle strengthening of forearm flexor–pronator mass.

• Initiate light strengthening of elbow flexors/extensors, shoulder, and scapular stabilisers.

Criteria to Progress:

• Full or near-full elbow range of motion.

• Improving strength without pain or instability.

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

Precautions:

• Avoid maximal valgus stress early in this phase.

Therapy:

• Advanced strengthening and endurance training.

• Work- and sport-specific rehabilitation.

• Graduated return to throwing activities if appropriate.

Criteria to Discharge:

• Full, pain-free elbow range of motion.

• Strength and control adequate for work and sport demands.

• No pain or instability with functional loading.

• Cleared by treating surgeon.

General Recommendations

Work:

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

• Manual labour should be deferred until 3–6 months 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 6–8 weeks.

• Progressive return to gym and functional activities from 8–12 weeks.

• Throwing, racquet sports, and higher-demand activities from approximately 3–4 months as strength and stability improve.

• Return to competitive throwing or high-demand overhead activities is usually delayed until 5–6 months or longer with full recovery and surgeon clearance.

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.