Lateral Epicondylitis Debridement/Repair

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-2

Aims:

• Pain/swelling control
• Protect elbow/wrist
• Allow the wounds to heal
• Maintain overall mobility including fingers

Suggested treatment:

• See hand therapy at 1 week – transition to TPS
• Continue to wear wrist brace most of the time (off for hygiene and therapy)
• Gentle finger ROM in post op TPS
• Gentle elbow, hand & wrist ROM focusing on elbow extension

Week 2-6

Aims:

• Wean out of sling
• Encourage range of motion – elbow and fingers

Suggested treatment:

• Mobilise elbow fully
• Progress to wrist AAROM
• Commence light stretching at 4 wks with focus on end-range and passive overpressure

Restrictions:

• No resisted extension of the wrist
• Wear brace most of the time; esp with ADLs

Week 6 and beyond

Aims:

• Minimal pain
• Increased active ROM
• Return to most normal activities

Suggested treatment:

• Can phase out of wrist splint
• Full AROM
• Avoid painful activities; consider counterforce brace if pain during exercise
• Light strengthening, begin isometrics and advance to eccentrics as tolerated
• Grip strength should be pain free with putty/ball

Restrictions:

• No heavy lifting till >3 months

Some General Questions

What to expect after surgery:

• Most patients will stay a night post operatively
• After you wake up, you might notice some numbness to fingers of the operated hand. This may be secondary to local anaesthetic and will wear off over 48-72 hours.
• The next morning, you will be seen by the medical team and physiotherapist or hand therapist prior to your discharge
• You will be sent home with medications or a script to help with pain relief
• You will need to see a hand therapist within the first 7 days of surgery – they will change your plaster half-cast into a moulded thermoplastic splint, as well as check your wounds.

Time in Sling:

• Generally your sling should be on most of the time in the first 2 weeks, for your comfort.
• From 2-6 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping
• From 6 weeks, you should not need to use your sling at all

Return to Activity

• Work
  Depends what you do. Desk based work can be done from 2 weeks post operatively, if you can do these tasks single handedly. Otherwise generally 6 weeks before you can use both hands freely whilst seated.
• Drive
  In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst you’re in a sling, you cannot drive. Generally 6 weeks post operatively.
• Sports/Hobbies:
• Gentle swimming: after 6 weeks
• Gardening (light tasks only): 6 weeks
• Bowls: after 6 weeks
• Golf, tennis, badminton, squash: after 3 months
• Weights: commence after 6 weeks

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.