conservative management and rehabilitation of lateral

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ConservativeManagementandRehabilitationofLateralElbow

Instability(1)PhaseI:Day1-4weeksLCLdeficienciesarebestsplintedwithelbowat90°offlexionandforearminpronation(SeeFig.1). This position approximates the radial head to the coronoid and reduces the stress on thelateral soft tissue structures. Supine exercises allow gravity to aid in ulnohumeral reductionwhilstmaintainingmotion.Theneedforsplintingandrateofprogressionfromactiveassistedtoresisted exercises is dependent on the degree of instabilitywhether the elbowdislocationhasbeenconservativelymanagedorsurgicallystabilised.

Figure1:Posteriorelbowsplintwithelbowat90°andpronatedforearmposition

• Thesplintisworncontinuouslyfor3-4weeksexceptforexercisesandskincareunless

theLCLhasbeensurgicallystabilisedinwhichcaseaslingshouldbeusedfor3-4weeks• Exercisescommencewithin1weekfollowingreductionoftheelbow• Introduceactiveassistedoroverheadexercises15xevery2hrs(SeeFigure2)• Progresstoactiveandthenresistedexercises• Forearmrotationexercisesonlyperformedwithelbowflexion90°orgreater• Shoulder,wristandfingeractivemotionexercisesthroughoutprogram

A V A N T H I M A N D A L E S O N M B B S ( H O N S ) , B M E D S C I , F R A C S , F A O R T H A

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Figure2:(A,B)Overheadflexionandextensioninsupinepositionwithshoulderflexedto90°andpronatedforearmpositionPhaseII:4to6weeksJointstabilityIsoftenachievedby4to6weeksfollowingtraumaorsurgery.Duringthisphaseofelbow rehabilitation, the goals are to maximise elbow and forearm range of motion whilstmaintainingelbowstabilityandmaximisingstrengthofthelateralmuscles.

• Discontinueposteriorelbowsplint• Collarandcufforslingtobewornwhenoutofthehouseorwhenactive,fracture

protection• Applyheatbeforeexercisetoincreasetissuecomplianceandgreaterarcofmotion• Flexion-Extensionexercisesperformedwithforearminneutralposition,25xeachhour

insupineorerectposition• Forearmrotationexercisescontinuesin90°ofelbowflexion• Wristanddigitalextensorstrengtheningincreasingresistance• Increasegripstrengtheningexercises• EncouragelightADL’savoidingthecombinedpositionofextensionandforearm

supination

A V A N T H I M A N D A L E S O N M B B S ( H O N S ) , B M E D S C I , F R A C S , F A O R T H A

H A N D A N D U P P E R L I M B S U R G E O N

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PhaseIII:6-12weeksRangeofmotion limitationsare liftedduring thisphase,as the jointshouldnowbestable.Thegoal of rehabilitation in this phase is to increasemobility, strength and endurance andoverallupperlimbfunction.

• Freeweightsandelasticbandscanbeincorporatedintotheprogramtoprogressstrength

• Strengtheningofelbowflexorswiththeforearminpronationforthefirst2weeksreducestheriskofrecurrentinstability

• Tricepsstrengthening• Shoulder,forearm,wristandhandstrengtheningmustbeincorporatedinthisphaseof

rehabilitation• Heatandstretch,passiverangeofmotionandstaticprogressivesplintingcanbehelpful

inrestoringflexioncontractures

References:

1. SzekeresM,ChinchalkarSJ,KingGJW.OptimizingElbowRehabilitationAfterInstability.HandClin.2008Feb;24(1):27–38.

2. ThisprotocolhasbeenadaptedwithpermissionfromAssocProfEugeneEkatMelbourneOrthopaedicGroupandtheHandtherapyDepartmentandDivisionofHandandUpperExtremitySurgery,HospitalforSpecialSurgery,NewYork