Download this rehabilitation protocol (PDF)
For patients and physiotherapists.
Week 0-2
Aims:
- Pain control
- Protect the ligament repair
- Allow the wounds to heal
- Maintain overall mobility
- Prevent development of HO
Suggested treatment:
- backslab
- Regular pain relief
- wrist/hand ROM exercises
- Sling most of the time, off for hygiene
- Celecoxib 200mg daily for 4 wks (HO prophylaxis)
Restrictions:
- Avoid AROM
Week 2-6
Aims:
- Wean out of sling
- Initiate ROM
- Protect repair
Suggested treatment:
- Thermoplastic splint – elbow at 90 degrees in supination. Gradually wean out over course of 4 wks
- Commence supine elbow active flexion + passive extension ROM
- Forearm neutral if both sides
- Forearm in pronation if lateral ligament only
- Standing ROM can commence at 4 wks
Restrictions:
- No heavy lifting
- Avoid shoulder IR (minimise stress on lateral repair)
Week 6-12
Aims:
- Work towards full ROM of elbow
- Strengthening and conditioning
Suggested treatment:
- Full active and passive ROM
Restrictions:
- No heavy lifting
Week 12 and beyond
Aims:
- Protect repair
- Improve endurance/power of operated shoulder
Suggested treatment:
- Heavy lifting allowed
- Patient specific exercises tailored to activities/sports
- Could consider capsular stretching if needed
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 Mr Lau 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 sling should be on at all times (except for hygiene) in the first 2 weeks
- From 2-6 weeks, you will be fitted with a thermoplastic splint which you should gradually wean out of over the 4 weeks. You should use your splint at night to start off with but will not need it by 6 weeks
- From 6 weeks, you should not need to use your sling at all
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.
Return to driving from earliest 6 weeks post op - 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
- Swimming: water based exercise is very helpful after surgery. No swimming until the wounds have healed – usually 2 weeks post operatively. Active swimming (eg freestyle) from 3 months.
- Golf: usually requires significant rehab and time before adequate protection of the rotator cuff repair has occurred. Usually 3 to 6 months post op
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.