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

Immobilisation:

• Posterior elbow splint or sling for comfort

• Removed regularly for exercises as directed

Precautions:

• Avoid heavy lifting or axial loading

• Avoid pushing up from a chair

• Avoid varus/valgus stress across the elbow

• Protect wound and soft tissues

Therapy:

• Early active and active-assisted range of motion within comfort

• Emphasis on regaining flexion and extension

• Forearm rotation exercises (supination/pronation)

• Hand, wrist, and shoulder mobility exercises

• Edema control and wound care

Criteria to Progress:

• Controlled pain and swelling

• Healing wound

• Improving range of motion

Phase II: Progressive Motion and Protection (2–6 Weeks)

Precautions:

• Avoid lifting >1–2 kg

• Avoid pushing, pulling, or weight-bearing through the arm

• Avoid sudden or uncontrolled movements

• Continue to avoid varus/valgus stress

Therapy:

• Progress to full active range of motion

• Continue forearm rotation exercises

• Begin gentle functional use of the arm

• Light isometric strengthening (biceps, triceps)

• Scapular and shoulder strengthening

Criteria to Progress:

• Functional range of motion

• Minimal swelling

• Good neuromuscular control

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

Precautions:

• Avoid heavy lifting or impact loading

• Avoid repetitive high-load activities

Therapy:

• Progressive strengthening (biceps, triceps, forearm musculature)

• Functional strengthening for activities of daily living

• Proprioceptive and coordination exercises

• Gradual increase in functional loading

Criteria to Progress:

• Good strength and control

• No significant pain or swelling

• Functional independence

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

Precautions:

• Avoid heavy lifting (>5–10 kg depending on surgeon guidance)

• Avoid repetitive high-load or impact activities

Therapy:

• Continued strengthening and endurance training

• Functional and task-specific training

• Gradual return to recreational activities within limits

• Criteria for Return to Activity

• Functional range of motion

• Good strength and endurance

• No pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks depending on comfort and arm use.

• Manual labour is typically deferred until 3–6 months depending on job demands and recovery progression.

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 from 6–8 weeks.

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

• Heavy lifting and high-impact activities are generally discouraged long term.

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.