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

Chapter 19 • Rehabilitation After ORIF of Elbow Dislocations

Table 19.3

Summary of Rehabilitation during Consolidation Phase

Strength and Endurance

Orthosis Management

Functional Goals

Protection ROM

HEP

Return to ADLs, recreational activities, return to work

AROM/PROM,

Static-progressive orthoses to achieve ROM goals

Isometrics progressing to PRES, functional

AROM/PROM Goal is full AROM and PROM.

Discontinue use of orthosis

strengthening exercises using weights, resistance bands

patterns (PNF), proximal muscle

strengthening (rotator cuff, scapular muscles), Work-simulated activities, including push/pull, lift/carry. Progress to weight- bearing activities and plyometrics.

AAROM = active assisted range of motion, ADLs = activities of daily living, AROM = active range of motion, IFC = interferential current therapy, PNF = proprioceptive neuromuscular facilitation, PRES = progressive resistive exercises, PROM = passive range of motion, ROM = range of motion, TENS = transcutaneous electrical nerve stimulation.

the patient has significant ROM loss, an orthosis may be used to obtain end-range motion. Custom-fabricated or commer- cially available splints, such as Dynasplint (Dynasplint System Inc, Severna Park, MD) or JAS (Joint Active Systems Inc, Eff- ingham, IL) may be worn to achieve this goal (Figure 19.12). We prefer custom orthotics that are remolded under the super- vision of a therapist. If the patient has limitation of both elbow flexion and extension, the patient may require two orthoses. In these cases, it is useful to wear the extension orthosis at night and the flex- ion orthosis at 30-minute intervals throughout the day. It is important to have the patient exercise in the newly available ROM upon orthosis removal to maintain ROM gains. Strengthening exercises are begun when bony union has occurred and soft tissues are not inflamed. Functional activ- ities and work conditioning are also performed. The work-simulated activities are tailored to the demands of the patient and the patient’s specific job.

Phase 3: Strengthening 1. Begin with isometrics in midrange 2. Progress to isotonic with light weight a. Bicep curls b. Tricep kickbacks/overhead tricep extension

c. Supination/pronation with resistance band/flexbar d. Wrist flexion/extension with weight or resistance band e. PNF patterns with weight or resistance band (Figure 19.13). 3. Closed-chain activities a. Push-ups i. Wall ii. Counter (Figure 19.14) iii. Floor iv. BOSU (Bosu Fitness LLC, San Diego, CA) (Figure 19.15) 4. Functional/work simulation Outcomes The approach to surgical treatment of elbow dislocations is determined by the extent of the anatomic injury, and has a bearing on the eventual outcome. For the terrible-triad patient, results were initially reported to be nearly uniformly poor. Improved understanding of the pathology and biomechanics of the elbow has led to about 70% good or excellent results with current treatment. Surgical indications for VPMI are still evolving, and reports of outcomes in these patients involve small case series. Simple elbow dislocations rarely require surgical stabilization, but when the elbow remains unstable a. Box lift (Figure 19.16) b. Push/pull (Figure 19.17) c. Plyometrics-Trampoline toss

Figure 19.12  Photograph of turnbuckle extension orthosis.

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© 2018 American Academy of Orthopaedic Surgeons

Postoperative Orthopaedic Rehabilitation