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

Immobilisation:

• Sling for comfort for 2 weeks

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

Precautions:

• No lifting, carrying, pushing, pulling, or weight bearing through the operated upper limb

• Avoid varus and valgus stress across the elbow

• Avoid axial loading through the arm

• Avoid combined elbow extension with forearm rotation

• Avoid pushing up from a chair or supporting body weight through the arm

Therapy:

• Oedema management and elevation

• Active wrist and hand range of motion

• Early active and active-assisted elbow flexion and extension in a protected range

• Forearm pronation and supination with elbow flexed and close to the body

• Shoulder range of motion avoiding rotational stress through the elbow

Criteria to Progress:

• Wound healed

• Pain controlled

• Minimal swelling

• Comfortable protected elbow motion

Phase II: Restore Motion (2–6 Weeks)

Immobilisation:

• Sling use gradually weaned beginning week 2

• 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:

• No lifting greater than a cup of tea

• Continue avoiding varus and valgus loading

• Avoid terminal elbow extension if unstable

• Avoid impact activities

Therapy:

• Progress elbow flexion and extension

• Progress forearm pronation and supination in protected positions

• Commence gentle active shoulder motion

• Scar management

Criteria to Progress:

• Functional elbow ROM

• Improving forearm rotation

• Minimal pain with movement

• Stable elbow throughout motion

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

Precautions:

• Gradually increase loading following evidence of healing and elbow stability

• Avoid repetitive loaded elbow extension

• Avoid heavy pushing, pulling, and weight-bearing activities

Therapy:

• Restore full elbow and forearm ROM

• Commence grip strengthening

• Progressive elbow and forearm strengthening

• Scapular and upper limb strengthening

Criteria to Progress:

• Functional ROM restored

• Stable elbow throughout range

• Improved strength

• Minimal pain with strengthening

Phase IV: Return to Function and Endurance (3–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into heavy loading or impact activities

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation as required

Criteria to Progress:

• Near full elbow and forearm ROM

• Functional strength restored

• Stable elbow

• Return to unrestricted activity

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 liaise with your insurance provider to confirm liability requirements.

• Driving should only resume once you are no longer requiring a sling and can safely control the vehicle and perform emergency manoeuvres.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light use of the operated upper limb may commence from approximately 6 weeks.

• Progressive return to functional and gym activities from approximately 3 months.

• Contact sport, racquet sports, or impact activities typically from 4–6 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.