OrthoAssociates - Upper Extremity Protocols.pdf

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33 Sewall Street
Portland, ME 04102
(207) 828 - 2100
www.orthoassociates.com
 
ELBOW FRACTURE WITH ORIF PROTOCOL
The following guidelines should be followed when treating a patient who has suffered a
fracture at the elbow, including fractures to the distal humerus and/or proximal ulna, with
subsequent surgery for internal fixation. It is important for the therapist to be in contact
with the surgeon to know severity of the fracture and what type of fixation was used,
and how this relates to specific referral instructions.
IMMOBILIZATION
A removable cast will be worn for the first 3 to 6 weeks, depending on the type of
fracture.
PHYSICAL THERAPY
Generally begun during the first week and includes the following.
1. ROM exercises for the upper extremity as needed, particularly early motion at
the elbow. Use of CPM should begin during the first week.
2. Progressive strengthening program. Usually begin with upper extremity
isometrics at week 3. Progression to free weights, etc is based on the type of
fracture and the fixation. Consider that the fracture site must be protected for
6 weeks to ensure healing.
3. Cardiovascular training with consideration to protecting the fracture site, ie no
weight bearing through the elbow when exercising.
4. Local modalities as indicated for pain and swelling.
5. Pool when the incision is healed.
6. Home Program: All patients must be on a home program to complement the
physical therapy program.
7. ADL’s: No lifting or carrying with the involved side until the fracture is healed
usually 6 weeks. Then lifting and carrying based on progression of strengthening
program. No driving until after 6 weeks.
* Depending on the patient’s condition, frequency of Physical Therapy will be decided
on an individual basis.
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33 Sewall Street
Portland, ME 04102
(207) 828 - 2100
www.orthoassociates.com
 
UPPER EXTREMITY STRENGTHENING EXERCISES
Prone extension
Lying on your stomach or bent over with your arm hanging down, pull back on
your shoulder blade like you are pulling it to your opposite hip pocket. Maintain
this position while you lift your straight arm up to the level of your hip and then
lower.
Reps__________ Sets__________ Tempo__________
Prone row
Lying on your stomach or bent over with your arm hanging down, pull back on
your shoulder blade like you are pulling it to your opposite hip pocket. Maintain
this position while you lift your bent elbow towards the ceiling and then lower.
Reps__________ Sets__________ Tempo__________
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33 Sewall Street
Portland, ME 04102
(207) 828 - 2100
www.orthoassociates.com
 
Shoulder blade push-up
On the ground either on your knees or on your toes with your hands in push-up
position. Pinch your shoulder blades together and then round out your back
while focusing on the muscles between the shoulder blades and not tightening up
into the neck.
Reps__________ Sets__________ Tempo__________
Serratus press
Stand and face away from a cable pulley or theraband and hold it in your hand
out at shoulder height. Keeping your arm straight, press your shoulder blade
forward and then back while keeping tension out of your neck muscles.
Reps__________ Sets__________ Tempo__________
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33 Sewall Street
Portland, ME 04102
(207) 828 - 2100
www.orthoassociates.com
 
Standing pull downs
Stand facing a cable pulley or theraband and hold it with both hands. Pull back
on your shoulder blades and maintain this position while you lower your arms to
your side and then back up.
Reps__________ Sets__________ Tempo__________
Standing rows
Stand facing a cable pulley or theraband and hold it with both hands. Pull back
on your shoulder blades and maintain this position while you pull the band
towards you with both hands. Try not to let the elbows go much past the plane of
the body. Progress to performing while
Reps__________ Sets__________ Tempo__________
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33 Sewall Street
Portland, ME 04102
(207) 828 - 2100
www.orthoassociates.com
 
External rotation
Standing with your side to a cable pulley or theraband, elbow bent 90 degrees
and a towel roll under your arm. Pull back on shoulder blade and rotate arm out
to the side in a pain-free range of motion and then back while maintaining good
shoulder blade retraction.
Reps__________ Sets__________ Tempo__________
Internal rotation
Standing with your side to a cable pulley or theraband, elbow bent 90 degrees
and a towel roll under your arm. Pull back on shoulder blade and rotate the arm
inward towards the body and then back while maintaining good shoulder blade
retraction.
Reps__________ Sets__________ Tempo__________
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