8-A836A-2018-Books-00085-Green chapter 19-ROUND1

Chapter 19 • Rehabilitation After ORIF of Elbow Dislocations

Figure 19.7  Photograph of ulnohumeral joint mobilization.

Figure 19.9  Photograph of active assisted elbow extension with a physioball.

in protected postures with the forearm in pronation and the elbow moving from flexion/extension, and are progressed to elbow flexion/extension with the forearm in supination. AROM exercises in proprioceptive neuromuscular facilitation (PNF) patterns are also useful at this stage to increase joint proprioception and encourage use of the arm in functional patterns. Manual force can be applied by the therapist and patient to provide graded resistance at varying points through- out the movement. In addition, the patient must perform inde- pendent exercises multiple times daily to maintain gains and increase mobility. Functionally, the patient should be encouraged to use the affected arm for light ADLs, such as self-care and meal prepa- ration. Styling hair, holding a cellphone, and tying neckties encourage elbow flexion. Folding laundry and typing promote forearm rotation. Patients are advised to allow the arm to swing naturally, avoiding the “sling” posture of elbow flexion, shoulder internal rotation, and adduction posture. Active and Active Assisted Elbow Flexion and Extension These exercises are begun with the forearm pronated and are progressed to supination as stability allows.

1. Physioball roll on plinth with forearm in pronation Patient uses bilateral upper extremities to roll the physioball on the plinth with forearms in pronation. This exercise can also be performed with the affected arm as an active exercise (Figure 19.9). 2. Active Assisted Elbow Extension with Cane Standing with the scapula against the wall, bend and straighten the elbow. A cane can be used to increase extension. Instruct the patient to keep the olecranon in contact with the wall to avoid external rotation from the shoulder. A towel may be placed behind the brachium for feedback to help the patient maintain the correct posture (Figure 19.10).

Figure 19.8  Photograph of radiohumeral joint mobilization.

Figure 19.10  Photograph of elbow extension cane stretch.

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© 2018 American Academy of Orthopaedic Surgeons

Postoperative Orthopaedic Rehabilitation