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LATERAL EPICONDYLITIS (TENNIS ELBOW) POSTOP PROTOCOL


Picture
Splint/sling immobilization for 7-10 days following open release and extensor origin repair.  Range-of-motion exercises are then commenced, and strengthening is started after 6 weeks. Postoperative splinting protocos until strength is regained. Continue wrist support splint for 10 to 14 days and a gradual return to activities, including sports (eg, golf, tennis), no earlier than 6 weeks postoperatively.


Upper extremity splint x 7-10 days

ROM exercises begun when splint removed

After wound is healed (10-14 days), therapy is continued, including edema control and ROM exercises, followed by strengthening exercises

Increased activity can be resumed within the limits of pain in 8 to 10 weeks

Full power should return in approximately 3 months

The rehab protocol is not time dependent, but rather goal dependent, with patients passing from one phase to the next after certain goals have been met




Phase 1: Acute

GOALS

1. Reduce inflammation and pain

2. Promote tissue healing

3. Retard muscular atrophy




TREATMENT REGIMEN

Cryotherapy

Stretching to increase flexibility

Wrist extension and flexion

Elbow extension and flexion

Forearm supination and pronation

High-voltage galvanic stimulation

Phonophoresis

Friction massage

Iontophoresis (with an antiinflammatory such as dexamethasone)

Avoiding painful movements (e.g., gripping)




Phase 2: Subacute

GOALS

1. Improve flexibility

2. Increase muscular strength and endurance

3. Increase functional activities and return to function




TREATMENT REGIMEN

Emphasize concentric and eccentric strengthening

Concentrate on involved muscle group or groups

Wrist extension and flexion

Forearm supination and pronation

Initiate shoulder strengthening (if deficiencies are noted)

Continue flexibility exercises

May use counterforce brace

Continue use of cryotherapy after exercise or function

Initiate gradual return to stressful activities

Gradually reintroduce previously painful movements




Phase 3: Chronic

GOALS

1. Improve muscular strength and endurance

2. Maintain and enhance flexibility 

3. Gradually return patient to sport or high-level activities




TREATMENT REGIMEN

Continue strengthening exercises (emphasize eccentric and concentric exercises)

Continue to emphasize deficiencies in shoulder and elbow strength

Continue flexibility exercises

Gradually diminish use of counterforce brace

Use cryotherapy as needed

Initiate gradual return to sport activity

Recommend equipment modifications (e.g., grip size, string tension, playing surface)

Emphasize maintenance program


From Wilk KE, Arrigo C, Andrews JR: Rehabilitation of he elbow in the throwing athlete, J Orthop Sports Phys There 17:305, 1993.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.
Sara Jurek, MD
First Hill: 206.386.2600
Copyright © 2020  Sara Jurek, MD.   All rights reserved.  601 Broadway Seattle, WA 98122


Contact        About         
  • DR. JUREK
    • APPROACH AND PHILOSOPHY
    • TRAINING
    • VOLUNTEER WORK
    • OUTSIDE OF MEDICINE
    • INSTAGRAM
    • PATIENT COMMENTS
  • THE OFFICE
    • FIRST HILL
    • WEST SEATTLE
    • VIRGINIA MASON HOSPITAL
    • SEATTLE SURGERY CENTER
    • SWEDISH ORTHOPEDIC INSTITUTE
  • PATIENT INFO
    • SHOULDER CONDITIONS
    • SPORTS MEDICINE
    • CORTISONE INJECTIONS
  • SURGERY
    • PREOP INFORMATION
    • GENERAL POSTOP INFORMATION
    • NARCOTIC FACT SHEET
    • NARCOTIC DISPOSAL
    • SPECIFIC POSTOP INSTRUCTIONS
    • SURGERY LOCATIONS
    • SHOULDER IMMOBILIZER INFO
    • ICE | CRYO-CUFF
    • PHYSICAL THERAPY POSTOP PROTOCOLS
  • FORMS
    • REQUEST AN APPOINTMENT
    • PATIENT FEEDBACK/TESTIMONIAL FORM
    • SPECIFIC POSTOP INSTRUCTION FORMS
  • BLOG
  • CONTACT