Modified McLaughlin

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-2

Aims:

• Pain control
• Protect the reconstruction
• Allow the wounds to heal
• Axilla/armpit hygiene

Suggested treatment:

• Ice and regular pain relief
• Elbow/wrist/hand and neck ROM exercises
• Brace most of the time, off for hygiene

Restrictions:

• Maintain arm in Gunslinger Brace
• No lifting objects
• No active abduction/forward elevation/ER

Week 2-4

Aims:

• Protect the reconstruction
• Return to light work/desk duties
• Functional activities at waist height

Suggested treatment:

• Begin passive; graduated to active pendular exercises at shoulder
• Ongoing elbow/wrist/hand mobility

Restrictions:

• Remain in Gunslinger Brace most of the time

Week 4-8

Aims:

• Restore range of motion
• Wean out of gunslinger brace (can be via broad arm sling if ongoing hesitation)

Suggested treatment:

• Commence range of motion exercises – commencing passive, then active
• Ongoing hand/wrist/elbow mobility

Restrictions:

• No IR beyond iliac crest
• No ER beyond neutral

Week 8-12

Aim:

• Regain full ROM
• Overhead activity

Suggested Treatment:

• Discontinue range of motion restrictions
• Gentle strengthening – consider closed chain scapular rehab with rotator cuff and deltoid strengthening

Restrictions:

• Gentle strengthening – avoid heavy lifting

Some General Questions

What to expect after surgery:

• Most patients will stay a night post operatively
• After you wake up, you may notice your whole arm feels numb from the local anaesthetic applied to the nerves of your arm – this should wear off approximately 12 hours after surgery
• The next morning, you will be seen by the medical team and physiotherapists prior to your discharge
• You will be sent home with medications or a script to help with pain relief

Time in Sling:

• Generally your brace should be on at all times (except for hygiene) in the first 4 weeks
• After 4 weeks, you can wean out of the brace gradually using it less and less each day; aiming to have gradually reduced its use till you are out of the brace by week 8. You do not need to use your brace at night/sleeping
• Sometimes, transitioning from the gunslinger brace to a broad arm sling is also helpful

Return to Activity

• Driving: when adequate range of motion and pain to allow safe control of the car and to react appropriately in an emergency. Both arms must be fully functional and on the wheel for this to occur. Usually dependent on time in sling so minimum 8 weeks.
  Return to driving from 8 weeks post op at earliest
• Work: desk based roles should be able to return once pain has settled – usually approximately 2 weeks after surgery. Those with more manual occupations may need specific recommendations and light duties are usually recommended

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.