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.