FLEXOR/PRONATOR MASS REPAIR

August 13, 2018

IMMEDIATE POSTOPERATIVE PHASE

Goals

• Protect healing tissue
• Decrease pain/inflammation
• Retard muscular atrophy
• Avoid strengthening the flexor mass muscle group during this initial phase to allow for healing at medial epicondyle

 

Weeks 1-2

• Brace: 90° elbow flexion
• Cryotherapy: To elbow joint
• Active assisted ROM
• Brace: Elbow ROM 0-120° (Gradually increase ROM – 5°, Ext/10° of Flex per week)
• Continue wrist ROM exercises
• Initiate light scar mobilization incision
• Cryotherapy to elbow

 

INTERMEDIATE PHASE

Goals

• Gradual increase to full ROM
• Promote healing of repaired tissue
• Regain and improve muscular strength
• Restore full function of graft site

 

Weeks 3-4

• Brace: Elbow ROM 0-140°
• Continue all exercises listed above
• Elbow ROM in brace
• Initiate active ROM Wrist and Elbow (No resistance)
• Initiate light wrist flexion stretching
• Initiate active ROM shoulder:
  • ER/IR tubing
  • Elbow flex/extension
  • Lateral raises
• Initiate light scapular strengthening exercises
• May incorporate stationary bike for lower extremity
• D/C brace and use wrist
• Begin light resistance exercises for arm (1 lb)
  • Wrist curls, extensions, pronation, supination
  • Elbow extension/flexion
• Progress shoulder program emphasize rotator cuff and scapular strengthening
• Initiate shoulder strengthening with light dumbbells

 

ADVANCED STRENGTHENING PHASE

 

Goals

• Increase strength, power, endurance
• Maintain full elbow ROM
• Gradually initiate sporting activities

 

Weeks 6-18

• ROM: Elbow ROM 0-135°
• Continue all Exercises: Progress all shoulder and UE exercises
• Progress elbow strengthening exercises
• Initiate shoulder external rotation strengthening
• Initiate eccentric elbow flexion/extension
• Continue isotonic program: forearm & wrist
• Initiate plyometric exercise program (2 hand plyos close to body only)
  • Chest pass
  • Side throw close to body
• Continue stretching calf and hamstrings
• Continue all exercises listed above
• Program plyometrics to 2 hand drills away from body
  • Side to side throws
  • Soccer throws
  • Side throws
• Initiate isotonic machines strengthening exercises (if desired)
  • Bench press (seated)
  • Lat pull down
• Initiate golf, swimming
• Continue strengthening program
• Emphasis on elbow and wrist strengthening and flexibility exercises
• Maintain full elbow ROM
• Initiate one hand plyometric throwing (stationary throws)
• Initiate one hand wall dribble
• Initiate one hand baseball throws into wall