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ULNAR NERVE TRANSPOSITION

0 to 2 weeks:

  • Squeeze soft sponge or a soft putty
  • Elbow supported in sling leaving the wrist free

 

NOTE: During the first two weeks following surgery, passive terminal elbow extension (i.e., last 5° – 10°) with wrist extension should be avoided.

 

2 to 4 weeks:

  • Remove sling.
  • Passive elbow ROM exercises, progressing to active/active assist ROM exercises.
  • May add shoulder ROM exercise, as needed.
  • Begin wrist (flexion and extension), forearm (pronation and supination) and hand and finger strengthening exercises.

 

1 to 2 months:

  • Continue shoulder and elbow ROM exercises and wrist & forearm strengthening exercises as above.
  • ADD elbow flexion and extension strengthening exercises
  • May add radial and ulnar strengthening exercises
  • Begin upper body ergometer (UBE) for upper extremity conditioning

 

2 to 3 months:

  • Progress to heavier weights as tolerated.
  • May begin shoulder strengthening exercises with light weight, if have not already started, with emphasis on the rotator cuff muscles.
  • At 2½ months, isokinetic wrist flexion & extension, and forearm pronation & supination exercises may be added.

 

3 to 4 months:

  • Perform Isokinetic Strength Test: wrist flexion & extension, forearm pronation & supination.
  • Continue with strengthening exercises to the wrist, elbow and shoulder, as needed.
  • May begin practicing functional or work-related activities, or sport specific drills (e.g., throwers may begin tossing, golfers begin putting, volleyball players begin passing and bumping).

 

NOTE: Apply ice after each session to help decrease the inflammatory response to microtrauma.