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

Immobilisation:

• Arm in a sling at all times, including during sleep

Precautions:

• No active elbow extension

• No pushing, lifting, or weight bearing through the operative arm

• Avoid shoulder extension and abduction with elbow extended

• Keep surgical site clean and dry

Therapy:

• Begin passive elbow flexion to 90° as tolerated, progressing gradually

• Passive elbow extension limited to 30° short of full extension

• Active wrist, hand, and shoulder ROM (excluding shoulder extension)

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

Criteria to Progress:

• Surgical site healing without complications

• Tolerates passive ROM within limits

• Patient adheres to precautions

Phase II: Controlled Motion Phase (2–6 Weeks)

Immobilisation:

• Continue sling for protection when not performing exercises

• Wean sling gradually by the end of week 6

Precautions:

• No active elbow extension until week 6

• Continue to avoid pushing/lifting

• Avoid positions that stress the triceps tendon (e.g., full extension with shoulder extension)

Therapy:

• Continue passive elbow flexion and extension, gradually increasing extension toward full

• Initiate active-assisted elbow flexion and extension after week 4

• Begin isometric wrist and hand strengthening

• Gentle scapular stabilisation and isometric shoulder work

Criteria to Progress:

• Pain-free passive ROM approaching full

• No signs of tendon stress

• Tolerating active-assisted motion

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• No resistance to elbow extension until week 10

• Avoid eccentric loading of the triceps

Therapy:

• Initiate active elbow extension without resistance

• Begin isometric triceps activation

• Progress to gentle isotonic strengthening of triceps around week 10

• Incorporate functional movement patterns and shoulder stability

Criteria to Progress:

• Near full, pain-free ROM

• Tolerance to light strengthening

• No signs of repair compromise

Phase IV: Progressive Strengthening and Functional Return (3–6 Months)

Precautions:

• Avoid forceful or explosive triceps activity

• No lifting greater than 5 kg until 6 months postoperative

Therapy:

• Progress resistance for triceps and upper limb musculature

• Begin closed-chain and functional strength training

• Emphasise endurance, coordination, and kinetic chain re-integration

• Sport-specific or job-specific training as needed

Criteria to Discharge:

• Full, pain-free ROM

• Triceps strength >85% of contralateral side

• Clearance from treating surgeon

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 4–6 weeks.

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

• Resisted elbow extension and pushing activities from approximately 10–12 weeks.

• Heavy lifting, pulling, and higher-demand activities 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.