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

Immobilisation:

• Sling worn at all times, removed only for therapy and hygiene.

Precautions:

• No lifting, pushing, or pulling with the operated arm.

• Avoid weight bearing through the arm.

• Avoid combined elbow extension and forearm rotation.

Therapy:

• Gentle passive and active-assisted elbow range of motion within comfort.

• 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 used as needed for comfort; removed for therapy and hygiene.

Precautions:

• Continue to avoid lifting, pushing, pulling, and weight bearing.

• Avoid forceful end-range elbow extension.

Therapy:

• Progress passive and active-assisted elbow range of motion.

• Begin gentle active elbow motion as tolerated.

• Continue shoulder, wrist, and hand exercises.

Criteria to Progress:

• Improving elbow range of motion.

• Pain minimal during daily activities.

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

Precautions:

• Avoid lifting more than 1 kg.

• No repetitive lifting or impact loading.

Therapy:

• Gentle functional strengthening for activities of daily living only.

• Emphasis on range of motion, control, and endurance rather than strength.

• Postural and proximal upper limb conditioning.

Criteria to Progress:

• Stable, pain-free elbow function for daily tasks.

• Functional range of motion achieved.

Phase IV: Long-Term Protection & Functional Maintenance (3–6 Months)

Precautions:

• Lifelong lifting limit of approximately 5 kg for single lifts.

• Avoid repetitive lifting greater than 1–2 kg.

• Avoid impact, pushing up from a chair, or weight bearing through the arm.

Therapy:

• Ongoing home exercise program focusing on mobility and light functional use.

• Education regarding lifelong activity modification.

Criteria to Discharge:

• Functional, pain-free elbow range of motion.

• Able to perform daily activities within lifelong restrictions.

• Understanding and adherence to permanent load limitations.

• Cleared by treating surgeon.

General Recommendations

Work:

• Desk-based work may resume after 4–6 weeks depending on comfort and arm use.

• Manual labour or heavy lifting work is not recommended following total elbow replacement.

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.

• Heavy lifting, pushing, or repetitive loading should be avoided long term (typically limited to ≤5–10 kg).

• High-impact, contact, or throwing activities are generally contraindicated following total elbow replacement.

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.