Elbow Surgery & Rehab Flashcards
What are the common types of elbow surgery?
- Fracture repair
- Release of common extensor origin (lateral epicondylitis)
- Ulna collateral ligament reconstruction
What are the common active early rehab treatments?
- Sling management
- Scapular setting
- Neck, shoulder, finger AROM
When is a fracture considered displaced and requiring surgery?
When separation is >2mm
What are the types of elbow fractures?
- Olecranon (fall/direct blow)
- Supracondylar (extension/flexion)
- Radial head (FOOSH)
What are the rehab principles for elbow fractures?
- AROM commences when surgeon allows (often early)
- PROM/resistance only once surgeon allows
What is the pathology of lateral epicondylitis (tennis elbow)?
- Microtears
- Other tendon pathologies
What is the conservative management for lateral epicondylitis?
- Activity modification
- NSAIDS
- Functional/counterforce bracing
- Therapeutic modalities
- Injection therapy
What are the indications for surgery for lateral epicondylitis?
Persistant & disabling symptoms despite conservative management
What is involved in surgery for lateral epicondylitis?
- Release of common extensor origin (CEO)
- Debridement of disease tendinous tissue to bleeding bone, mostly ECRB origin
- Reattachment of tendon
What are the 0-5 day rehab goals post CEO surgery?
- Elevation
- Gentle AROM for hand, neck, shoulder
- Post-operative splint, elbow at 90 deg
What are the day 5 rehab goals post CEO surgery?
- Removal of post surgical dressing & splint
- AROM for hand, wrist, elbow, shoulder, cervical spine
- Monitor pain, swelling, wound healing and functional ability
How can functional ability be monitored?
Using the DASH (disabilities of the arm, shoulder & hand) or the PRTEE (patient-rated tennis elbow evaluation) questionnaire
What is contraindicated on day 5 post CEO surgery?
PROM & joint mobilisation of the elbow/forearm
What does the ulnar collateral ligament protect against in the elbow within a function ROM?
Valgus stress
What movement may promote valgus stress at the elbow that exceeds the ultimate tensile strength of the UCL?
- Throwing motions
- Repetitive may eventually cause the UCL to overstretch and create medial elbow instability
What does reconstruction of the UCL with ulnar nerve transposition involve?
- Medial incision of the cubital tunnel along inter muscular septum & FCU
- Ulnar nerve transposed anteriorly & secured under fascia of flexor/pronator muscles
What donor tendon can be used as an alternative in UCL reconstruction?
- Palmaris longus if present either side
- Otherwise plantaris, extensor tendon 4th toe
What does the post op rehab for UCL involve?
- 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
What does the post op rehab for UCL donor site involve?
- Submax shoulder isometrics (except ER)
- AROM of wrist
- Monitoring of ulnar nerve
What does the post-op rehab for UCL involve at day 7?
- 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
