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FLEXOR/PRONATOR MASS REPAIR

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