Elbow Surgery & Rehab

Question 1

What are the common types of elbow surgery?

Answer 1

• Fracture repair
• Release of common extensor origin (lateral epicondylitis)
• Ulna collateral ligament reconstruction

Question 2

What are the common active early rehab treatments?

Answer 2

• Sling management
• Scapular setting
• Neck, shoulder, finger AROM

Question 3

When is a fracture considered displaced and requiring surgery?

Answer 3

When separation is >2mm

Question 4

What are the types of elbow fractures?

Answer 4

• Olecranon (fall/direct blow)
• Supracondylar (extension/flexion)
• Radial head (FOOSH)

Question 5

What are the rehab principles for elbow fractures?

Answer 5

• AROM commences when surgeon allows (often early)

- PROM/resistance only once surgeon allows

Question 6

What is the pathology of lateral epicondylitis (tennis elbow)?

Answer 6

• Microtears

- Other tendon pathologies

Question 7

What is the conservative management for lateral epicondylitis?

Answer 7

• Activity modification
• NSAIDS
• Functional/counterforce bracing
• Therapeutic modalities
• Injection therapy

Question 8

What are the indications for surgery for lateral epicondylitis?

Answer 8

Persistant & disabling symptoms despite conservative management

Question 9

What is involved in surgery for lateral epicondylitis?

Answer 9

• Release of common extensor origin (CEO)
• Debridement of disease tendinous tissue to bleeding bone, mostly ECRB origin
• Reattachment of tendon

Question 10

What are the 0-5 day rehab goals post CEO surgery?

Answer 10

• Elevation
• Gentle AROM for hand, neck, shoulder
• Post-operative splint, elbow at 90 deg

Question 11

What are the day 5 rehab goals post CEO surgery?

Answer 11

• Removal of post surgical dressing & splint
• AROM for hand, wrist, elbow, shoulder, cervical spine
• Monitor pain, swelling, wound healing and functional ability

Question 12

How can functional ability be monitored?

Answer 12

Using the DASH (disabilities of the arm, shoulder & hand) or the PRTEE (patient-rated tennis elbow evaluation) questionnaire

Question 13

What is contraindicated on day 5 post CEO surgery?

Answer 13

PROM & joint mobilisation of the elbow/forearm

Question 14

What does the ulnar collateral ligament protect against in the elbow within a function ROM?

Answer 14

Valgus stress

Question 15

What movement may promote valgus stress at the elbow that exceeds the ultimate tensile strength of the UCL?

Answer 15

• Throwing motions

- Repetitive may eventually cause the UCL to overstretch and create medial elbow instability

Question 16

What does reconstruction of the UCL with ulnar nerve transposition involve?

Answer 16

• Medial incision of the cubital tunnel along inter muscular septum & FCU
• Ulnar nerve transposed anteriorly & secured under fascia of flexor/pronator muscles

Question 17

What donor tendon can be used as an alternative in UCL reconstruction?

Answer 17

• Palmaris longus if present either side

- Otherwise plantaris, extensor tendon 4th toe

Question 18

What does the post op rehab for UCL involve?

Answer 18

• Posterior elbow splint at 90 deg
• Allows initial healing of UCL graft & soft tissue healings of fascial slings for transferred nerve
• Oedema/pain managed with frequent gripping exercises, cryotherapy & bulky dressing
• Dressing removed day 5-7

Question 19

What does the post op rehab for UCL donor site involve?

Answer 19

• Submax shoulder isometrics (except ER)
• AROM of wrist
• Monitoring of ulnar nerve

Question 20

What does the post-op rehab for UCL involve at day 7?

Answer 20

• Posterior splint removed, elbow placed in hinged brace set at 30-100 deg
• ROM increased weekly by 10 deg of flexion/extension
• Forearm supination/pronation ROM assessed & progressed in week 2