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

Immobilisation:

• Sling worn for comfort, removed for therapy and hygiene.

Precautions:

• Avoid prolonged elbow flexion.

• Avoid direct pressure over the medial elbow.

• Avoid lifting, pushing, pulling, or weight bearing with the operated arm.

Therapy:

• Gentle active elbow range of motion within comfort.

• Hand, wrist, and shoulder range of motion exercises.

• Nerve gliding exercises as tolerated.

• 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.

Precautions:

• Continue to avoid prolonged or forceful elbow flexion.

• Avoid repetitive valgus stress at the elbow.

Therapy:

• Progress elbow range of motion.

• Continue ulnar nerve gliding exercises.

• Gentle forearm, wrist, and hand strengthening.

• Shoulder and scapular range of motion exercises.

Criteria to Progress:

• Improving elbow motion.

• Neurological symptoms stable or improving.

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid sustained pressure on the medial elbow.

Therapy:

• Progressive strengthening of forearm, hand, and elbow musculature.

• Advance shoulder and scapular strengthening.

• Functional upper limb strengthening as tolerated.

Criteria to Progress:

• Full or near-full elbow range of motion.

• Strength improving without symptom recurrence.

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

Precautions:

• Avoid prolonged or repetitive pressure on the ulnar nerve.

Therapy:

• Advanced strengthening and endurance training.

• Work- and sport-specific rehabilitation.

Criteria to Discharge:

• Full, pain-free elbow range of motion.

• Resolution or stable improvement of neurological symptoms.

• Strength sufficient for work, sport, and daily activities.

• Cleared by treating surgeon.

General Recommendations

Work:

• Office/desk work may resume after 1–2 weeks if pain is well controlled

• Manual labour should be deferred until 6–12 weeks 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 4–6 weeks.

• Resisted elbow flexion, gripping and wrist flexion from approximately 6–8 weeks.

• Higher-demand activities from 2–3 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.