Penrose Physical Therapy
Jan 2016
Jennifer Penrose
Jennifer Penrose

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.



  • Decrease pain and swelling
  • Increase nutrition and healing response
  • Infection prevention


  • 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


  • 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


  • 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

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

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