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

Immobilisation:

• Arm supported in a standard sling at all times

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

Precautions:

• Strict avoidance of varus stress on the elbow to protect the coronoid repair.

• Avoid active elbow extension beyond 30° short of full extension.

• No lifting or weight bearing with the affected arm.

Therapy:

• Commence overhead elbow protocol in supine position with:

• Shoulder flexed to 90°, adducted, neutral to slight external rotation (minimizes gravity effect and varus stress).

• Active assisted forearm pronation/supination with elbow at 90° flexion.

• Active assisted elbow flexion with no limit.

• Active/active-assisted elbow extension limited to 30° short of full extension.

• Passive elbow ROM within prescribed limits (30°–90° flexion).

• Wrist and shoulder active ROM exercises.

• Oedema and pain control.

Criteria to Progress:

• Controlled pain and swelling.

• Ability to tolerate overhead protocol without increased symptoms.

Phase II: Controlled Motion Phase (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:

• Continue to avoid varus stress.

• Elbow extension limited to 30° short of full extension.

• No lifting or resisted elbow extension.

Therapy:

• Progress active-assisted to active elbow flexion and pronation/supination exercises in overhead position.

• Gradual increase of passive elbow extension towards full extension as tolerated.

• Initiate gentle isometric strengthening of shoulder and wrist muscles.

• Continue oedema control.

Criteria to Progress:

• Functional elbow flexion 30° to 120° with minimal pain.

• Tolerating strengthening without varus stress.

Phase III: Strengthening Phase (6–12 Weeks)

Immobilisation:

• Discontinue sling as tolerated.

Precautions:

• Avoid heavy lifting and varus stress.

Therapy:

• Begin isotonic strengthening of elbow flexors, extensors (gradual), and shoulder muscles.

• Functional training including light activities of daily living.

• Continue overhead anti-gravity exercises to maintain elbow stability.

Criteria to Progress:

• Near full elbow ROM.

• Adequate strength to perform daily activities without pain.

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

Precautions:

• Avoid activities that risk varus stress or trauma.

Therapy:

• Advance strengthening and endurance.

• Gradual return to full work and leisure activities as tolerated.

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, contact, or high-impact activities should only resume after full clearance by the treating surgeon, typically after 3–4 months.

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.