Medial Epicondyle Humerus ORIF

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Phase I- Protective Phase (Weeks 0 – 3)

Goals:

  • Protect healing tissues and minimize deleterious stresses
  • Decrease pain, inflammation and swelling
  • Gradual return of protected AROM

Week 1

  • Brace: Functional Hinge Brace at 90° of elbow flexion
  • Elbow Compression dressing for 2-3 days (post-cast removal)
  • Exercises:
    • Gripping
    • Scap Squeeze

Week 2

  • Brace: ROM set at 20° – 100°
  • Exercises:
    • Continue exercises listed above
    • Initiate active elbow flexion and extension within brace limits
    • Elbow PROM in brace
    • Elbow extension isometrics

Week 3

  • Brace: ROM set at 10° – 110°
  • Exercises:
    • Continue exercises listed above
    • Elbow PROM in brace
    • Initiate AROM wrist and elbow (no resistance)

Phase II – Intermediate Phase (4 – 8 Weeks)

Goals:

  • Gradually increase ROM to attain FROM by week 4 - 6
  • Promote healing of tissue
  • Regain and improve muscular strength

Week 4

  • Brace: Elbow ROM 0° -125° 
  • Exercises:
    • Begin light bicep curls – 1 lbs
    • Being wrist pronation/supination/flexion
    • Cont elbow AROM flex/ext
    • Shoulder Isotonics/T-band (NO ER until week 6)

Week 5

  • Discontinue brace
  • ROM: Elbow ROM 0° -135°
  • Continue all exercises

Weeks 6 – 8

  • ROM: Full ROM (0° -145°)
  • Begin shoulder ER exercises to compliment existing shoulder/scapular exercises
  • If needed – can being low-load stretching for elbow extension

Phase III – Advanced Strengthening Phase (Weeks 9 - 13)

Goals:

  • Increase strength, power and endurance 
  • Gradually initiate sports activities

Weeks 9 - 16

  • Progress isotonic program
  • Begin isokinetic program for shoulder and elbow
  • Begin plyometric program at week 11
  • If baseball player - begin hitting at week 11

Phase IV – Return to Activity Phase (Weeks 16 – 26)

Goals:

  • Gradual return to sport activities
  • Continue stretching/strengthening program

Week 16

  • Initiate throwing/interval sports program

Phase V – Return to sport (6 months)

  • Return to mound program/positional play

Criteria for return to play:

  • Physician approval
  • Full, non-painful ROM
  • Satisfactory strength test
  • Satisfactory clinical exam
  • Satisfactory completion of interval sport program

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