Click the “read more” button to see the full protocol for Medial & Lateral Epicondylitis, non-surgical approach. This is a sample surgical protocol that we typically use. We will always communicate with your surgeon on your surgery and their preferred protocol.
0-3 WEEKS
Goals:
- Decrease pain and swelling
- Increase nutrition and healing response
- Infection prevention
Precautions:
- Sling/abduction pillow is worn for 2 weeks during the day and night
- Sling use as indicated by repair
- Remove sling for light activity and home exercise program as indicated by therapist
- Limit external rotation to neutral for 2 weeks
- No active external rotation for 2 weeks
- No active motion for 4 weeks, all planes
- No weights/PRE (progressive resistance exercise) for 8 weeks
Exercises (PROM):
- Begin passive ROM exercises in clinic
- Pendulum exercise without weight: clockwise, counterclockwise, side-to-side, front-back
- PROM: ER, IR, flexion, extension
- Table slides
- Scapular retractions
- Wrist/elbow exercises
- Grip exercises
Other:
- Ice 3x/day for 20 minutes, or as indicated by therapist
- Continue to ice as needed and/or indicated throughout rehabilitation
- Modalities
- Continue as needed and/or indicated throughout rehabilitation
- Wound inspection
3-4 WEEKS
Precautions:
- No active motion, all planes
- No weights/PRE
Exercises (AAROM):
- Pendulum exercises with light weight
- AAROM with cane & pulleys, to patient tolerance
- flexion, abduction – ER to neutral
- Body Blade – opposite hand, straight plane
- Shoulder shrugs – light weight/high reps
Progress with:
- Wall climbing/finger ladder
- Scar mobility
- Quadruped rhythmic stabilization
- Body Blade – opposite hand diagonals with trunk rotation
- Biceps curls
- Shoulder extension with Theraband
- Shoulder shrugs
- UBE – active assist only
WEEK 4-6
Precautions: No weights/PRE
Exercises (AROM)
- Continue with Week 3-4 AAROM exercises
- AAROM exercises with cane
- AROM – all planes
- UBE – forward/reverse
- Scapular retraction
- Prone extension
- Supine “holds” at 90° flexion; progress to small circles
- Side-lying “holds” at 90° abduction; progress to small circles
- Isometrics <50% effort, no pain (flexion, extension, abduction, ER)
- Biceps curls/triceps extensions with light resistances, elbow at side
WEEK 6-8
Goal: Should have full PROM
Exercises (AROM):
- Continue with Week 4-6 exercises, no weight
- Low-weight exercise (begin at 90° and increase to full ROM)
- flexion/extension
- abduction
- rows
- scaption
- Wall push-ups, wall push-ups plus
- Shoulder IR/ER with low resistance
- Scapular protraction (“serratus punch”)
- Prone fly
WEEK 8-12
Goal: Should have full AROM; if not, begin passive stretch to achieve full ROM
Exercises (Strength):
- Body Blade, involved extremity
- One-handed grip, abduction to 90°
- Two-handed grip, flexion to 90°
- Kneeling push-ups, kneeling push-ups plus
- Step-ups in kneeling push-up position
- UBE with increased resistance
- StairMaster in quadruped at level 12-15
- Treadmill in quadruped at 1.0 mph
- Plyoball:
- Circles, CW & CCW, 1 minute each direction
- Squares, CW & CCW, 1 minute each direction
WEEK 12-16+ (Return to Sport-Specific Training)
- Continue with Phase IV Strength, increasing reps and resistance as tolerated
- Isokinetic testing as directed by physician
- Functional testing as directed by physician
- Push-ups, push-ups plus
- Step-ups in push-up position
- Sport-specific exercises as directed by physician and therapist
References:
Adapted from Rehab Protocol for Small (<2 cm) Rotator Cuff Repair of the Department of Sports Medicine & Shoulder Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Click here to download: Rotator cuff repair – small
