LATERAL EPICONDYLITIS (TENNIS ELBOW) POSTOP PROTOCOL
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.
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.
