Days 0-2:
After surgery the elbow is wrapped in velband and crepe, which should be removed at 48 hours and replaced with a tubigrip (supplied by physiotherapist prior to surgery or discharge). The patient is provided with a sling. The surgical wound(s) is (are) covered with showerproof dressing(s). The arm should be kept elevated by maintaining the elbow at or above chest height to control swelling.
Days 3-14:
Elevation should be continued for the first 7-10 days. Ice –packs may also be used for up to 20 minutes, 2-3 times a day, to control inflammation and swelling.
The dressings should be left in place until the wounds are dry. Patients may shower, wiping the dressings dry afterwards. If the dressings come off they should be replaced with waterproof plaster. Sutures may be removed at the outpatient visit or in some instances by a district or practice nurse.
Assisted and active movements of the elbow, forearm and wrist may be started as tolerated. Daily activities may be started as tolerated including showering, dressing, self-care and deskwork. Any activities that cause pain should be avoided. The sling should be worn when going outdoors.The sling may be discarded after 10-14 days.
Driving may be commenced when the patient can comfortably extend the elbow and use the hand, usually within 1-2 weeks after surgery. Patients in sedentary occupations should aim return to work by 2 weeks. An outpatient visit with the surgeon takes place at 2 weeks.
Week 3-6:
Active range of motion exercises should be performed with at least 10 repetitions, 3 times a day. This should include flexion and extension (bending and straightening) of the elbow, supination and pronation of the forearm (turning the palm up and down), flexion and extension of the wrist (bending forwards and backwards) and flexion and extension of the fingers (clenching and unclenching the fist). The patient should aim to regain full movements by 14-21 days after surgery.
Activities against light resistance or with light loads (ie upto 1 lb) may be performed after 3 weeks, if tolerated, and a counterforce brace should be worn if necessary. Vigorous or repetitive activities (eg hoovering) should be avoided. Patients with manual occupations should be restricted to light duties during this phase.
An outpatient visit with the surgeon takes place at 6 weeks.
Weeks 7-12:
Stretching should be performed to maintain range of movements. Formal strengthening can be started at this stage. This should include eccentric loading and concentric exercises against resistance. The use of a counterforce brace should be continued for up to 8 weeks and thereafter at the patient’s discretion. Patients may gradually return to high demand activities and sports after 8 weeks with appropriate sports specific exercises and guidance provided by the physiotherapists.
Patients will be seen in the outpatients clinic at 12 weeks after surgery.
Unrestricted activities are allowed after 12-16 weeks depending on progress.