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

Immobilisation:

• Sling worn at all times

• Remove sling only for hygiene and supervised therapy

Precautions:

• No active wrist and finger flexion or forearm pronation

• Avoid lifting, gripping, or resisted hand/wrist motions

• Protect surgical site—keep clean and dry

• Avoid valgus stress across the elbow

Therapy:

• Begin hand, wrist, and shoulder active range of motion (excluding wrist flexion/pronation)

• Elbow passive flexion/extension in pain-free range

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

Criteria to Progress:

• Satisfactory wound healing

• Pain control with basic daily activities

• Elbow range of motion improving without stress to repair

Phase II: Controlled Mobilisation and Early Strengthening (2–6 Weeks)

Immobilisation:

• Discontinue sling after week 2

• Consider counterforce brace or forearm support as needed for comfort

Precautions:

• Avoid valgus stress and resisted wrist flexion/pronation

• No lifting or carrying heavy objects

• Avoid pushing motions

Therapy:

• Progress to active elbow flexion/extension and forearm rotation

• Gentle active-assisted and passive wrist extension

• Begin isometric wrist extension and supination

• Avoid resisted wrist flexion/pronation

• Scapular control and shoulder activation exercises continue

Criteria to Progress:

• Improved elbow and wrist range of motion

• Minimal pain with ADLs

• Controlled active movements without symptoms

Phase III: Strengthening and Neuromuscular Training (6–12 Weeks)

Precautions:

• No heavy lifting or resisted wrist flexion until 10–12 weeks

• Avoid repetitive valgus-loading activities

Therapy:

• Begin light resistance strengthening for wrist and forearm (excluding wrist flexion/pronation until week 10)

• Introduce eccentric wrist extensor loading

• Grip strengthening, proprioception, and endurance exercises

• Begin light functional and sport-specific movements as tolerated

Criteria to Progress:

• Near-full, pain-free ROM

• Functional strength for daily activities

• No instability or inflammation

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

Precautions:

• Avoid forceful valgus loading or high repetition grip work until cleared

Therapy:

• Full strengthening of wrist, forearm, and elbow

• Progressive functional return to occupation and sport

• Plyometric and load-tolerance drills if indicated (e.g., for throwing athletes)

• Gradual reintroduction of gym and sporting activity

Criteria to Discharge:

• Full, pain-free ROM

• Symmetrical strength

• Functional performance without pain or instability

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 2–4 weeks.

• Progressive return to gym and functional activities from 6–8 weeks.

• Resisted elbow flexion, gripping and wrist flexion from approximately 8–10 weeks.

• Golf and higher-demand activities from 3–4 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.