Elbow Arthroscopy with Drilling/Excision

General Notes: 
  • “As tolerated” should be understood to include with safety for the surgery; pain, swelling, or other undesirable factors are indicators that you are doing too much too soon. If any of these should occur, decrease activity level and ice.
  • Ice should be applied to the elbow for 15-20 minutes following each exercise, therapy, or training session.
  • Return to sport is based on provider team (physician, physician assistant, athletic trainer, therapist) input and appropriate testing.
  • All times and exercises are to serve as guidelines. Progression through the protocol should be based upon criteria as opposed to dates listed and will vary depending on each individual patient. Progress  should be agreed upon by the patient and his/her team of providers.
     

Phase I: Weeks 0-4

Brace: 
  • As needed to restrict motion
  • Utilize sling for comfort-take arm out of sling and gently straighten elbow at least 3x/day (unless braces or immobilized)
ROM:
  • Progress to full and painless
Therapeutic Exercises: 
  • Finger, hand and wrist motion encouraged
  • Initiate isometrics and progress to isotonics as tolerated in available ROM
  • UBE for ROM only
  • Core Strengthening initiated as tolerated
  • Periscapular and shoulder strengthening 
  • All therapeutic exercises should be completed in a non-weight bearing manner
Manual Therapy:
  • Joint mobilizations to increase pain free ROM
  • Scar Massage
Proprioception:
  • Non-weight bearing rhythmic stabilization drills
Cardio:
  • Stationary bike and elliptical may be initiated as tolerated
Modalities:
  • Cryotherapy
  • Electrical stimulation

Phase II: Weeks 4-6

Brace: 
  • None
ROM:
  • Full and painless.
Therapeutic Exercises: 
  • UBE
  • Core strengthening
  • Periscapular and shoulder strengthening
  • Isotonic elbow, forearm and wrist strengthening
  • All therapeutic exercises should be completed in a non-weight bearing manner for arthroscopic drilling
Proprioception: 
  • Non-weight bearing rhythmic stabilization drills
Cardio: 
  • Stationary bike and elliptical
Modalities:
  • Cryotherapy
Progression to Phase III: 
  • Involved shoulder and elbow strength 80% of non-involved side
  • Satisfactory proprioception

Phase III: Week 6-12

Brace:
  • None
ROM:
  • Full and painless
Therapeutic Exercises: 
  • UBE
  • Core strengthening
  • Periscapular and shoulder strengthening
  • Isotonic, elbow, forearm and wrist strengthening
  • Initiate weight bearing exercises and plyometrics week 8 for arthroscopic drilling
Proprioception: 
  • Rhythmic stabilization drills
Cardio:
  • Stationary bike and elliptical
Modalities:
  • Cryotherapy
  • Electrical stimulation as needed
Progression to Phase IV:
  • Involved shoulder and elbow strength to 100% of non-involved side
  • Satisfactory proprioception
  • No pain with weight bearing through involved extremity

Phase IV: Weeks 12 - Beyond

Brace:
  • None
ROM:
  • Full and painless
Therapeutic Exercises: 
  • UBE 
  • Core strengthening
  • Periscapular and shoulder strengthening
  • Weight bearing and plyometric exercises
  • Initiated return to throwing program week 12
Proprioception: 
  • Rhythmic stabilization drills
Cardio:
  • Stationary bike and elliptical
Modalities:
  • Cryotherapy
  • Electrical stimulation as needed
Progression to Phase V:
  • Successful completion of interval throwing program

Phase V: Return to Play

Follow up testing determined by your healthcare team:

Overhead Athletes

ROM: shoulder and elbow

Strength:

  • Manual muscle testing shoulder and elbow
  • Isokinetic testing shoulder and elbow
  • Grip strength

Proprioception

  • shoulder

Functional tests

  • Specific to throwing

Upper Extremity Weight Bearing Athletes

ROM:  Elbow

Strength:

  • Manual muscle testing
  • Isokinetic testing
  • Grip strength

Proprioception

Functional Tests

  • Specific to weight bearing