Common Extensor Tendon (Elbow) Repair

Physical Therapy Protocol

Phase I – Protection & Early Motion (Weeks 0–2)

Goals:

• Protect the surgical repair.
• Reduce pain and inflammation.
• Maintain joint mobility of wrist, fingers, and elbow.

Precautions:

• Wear a splint full-time until the first post-op visit.
• Sling for arm support as needed for comfort.
• Wrist brace required at all times (except during therapy and hygiene) after the post-op splint is removed.
• No lifting with the surgical extremity.
• No repetitive activity.

Clinical Care:

• Swelling and wound management: Monitor for excessive swelling, redness, heat, drainage, or worsening pain.
• Ice and elevation to control inflammation.
• Pain control: Follow prescribed post-op pain regimen.

Exercises:

• Gentle ROM of fingers while in the post-op splint.
• Passive and active-assisted ROM of hand, wrist, and elbow.
• Focus on terminal elbow extension.

Criteria to Advance:

• Splint removal after the first post-op visit.
• Minimal pain with gentle ROM exercises.

Phase II – Motion & Progressive Mobilization (Weeks 2–6)

Goals:

• Restore full pain-free elbow, wrist, and forearm ROM.
• Begin light functional use of the hand and arm.

Precautions:

• Continue wrist brace for ADLs, but begin weaning as tolerated starting at 2 weeks.
• No resistance exercises for the surgical extremity.
• No repetitive activity.

Clinical Care:

• Protect repair while restoring ROM.
• Continue swelling management.
• Initiate light scar mobilization once the wound is fully healed.

Exercises:

• Full elbow ROM goal: Flexion, extension, supination, and pronation by 4–6 weeks.
• Maintain ROM of non-affected joints (shoulder, fingers).
• Begin shoulder isometrics.
• Progress to active-assisted ROM (AAROM).
• Light stretching can begin at 4 weeks, emphasizing end-range and passive overpressure (low load/long duration).

Criteria to Advance:

• At least 6 weeks of healing since surgery.
• Pain-free ROM to at least 120° flexion and 0° extension.
• Supination/pronation near symmetrical with the non-operative side.

Phase III – Strengthening & Functional Progression (Weeks 6–12)

Goals:

• Initiate pain-free strengthening.
• Improve grip strength and endurance.
• Continue progression of ROM and functional use.

Precautions:

• No lifting >5 lbs.
• Minimize repetitive activity to prevent irritation.

Clinical Care:

• Continue to phase out wrist brace as tolerated.
• Minimize inflammation and avoid pain-provoking activities.
• Use a counterforce elbow strap during exercise if pain persists.

Exercises:

• Begin light strengthening with pain-free isometrics for the wrist and elbow.
• Advance to resistance exercises and eccentric strengthening as tolerated.
• Strengthening progression:
  • Tubing or light weights (≤1 lb) for elbow flexion, extension, supination, and pronation starting at 8 weeks.
  • Slowly increase resistance as symptoms allow.
  • Grip strengthening using putty or a ball (must be pain-free).

Criteria to Advance:

• At least 10 weeks of healing since surgery.
• Full pain-free ROM achieved.
• Improving strength without increased discomfort.

Phase IV – Return to Full Activity (Weeks 12–16+)

Goals:

• Restore full functional use.
• Improve endurance and prevent re-injury.

Precautions:

• Gradual return to heavier lifting.
• Limit repetitive high-load activities.

Clinical Care:

• Continue progressive strengthening and endurance training.
• Gradual return to full functional and sport-specific activities.

Exercises:

• Begin task-specific functional movements.
• Continue progressive strengthening for wrist, forearm, and shoulder as needed for work/sport.

Return to Work/Sport:

• At least 12 weeks of healing.
• Symptom-free task/sport-specific activity tolerated.

Final Notes:

• Progression should be guided by pain tolerance and functional milestones.
• Modify activity levels based on individual recovery rates.
• Contact the surgeon if pain, stiffness, or swelling persist beyond expected recovery time.