or tho associates - upper extremity protocols

8/8/2019 Or Tho Associates - Upper Extremity Protocols

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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 afracture at the elbow, including fractures to the distal humerus and/or proximal ulna, withsubsequent surgery for internal fixation. It is important for the therapist to be in contactwith 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 offracture.

PHYSICAL THERAPYGenerally begun during the first week and includes the following.1. ROM exercises for the upper extremity as needed, particularly early motion atthe elbow. Use of CPM should begin during the first week.2. Progressive strengthening program. Usually begin with upper extremityisometrics at week 3. Progression to free weights, etc is based on the type offracture and the fixation. Consider that the fracture site must be protected for6 weeks to ensure healing.3. Cardiovascular training with consideration to protecting the fracture site, ie noweight 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 thephysical therapy program.7. ADL’s: No lifting or carrying with the involved side until the fracture is healedusually 6 weeks. Then lifting and carrying based on progression of strengtheningprogram. No driving until after 6 weeks.

* Depending on the patient’s condition, frequency of Physical Therapy will be decidedon an individual basis.



33 Sewall Street

Portland, ME 04102

(207) 828-2100


UPPER EXTREMITY STRENGTHENING EXERCISES

Prone extensionLying on your stomach or bent over with your arm hanging down, pull back onyour shoulder blade like you are pulling it to your opposite hip pocket. Maintainthis position while you lift your straight arm up to the level of your hip and thenlower.Reps__________ Sets__________ Tempo__________

Prone rowLying on your stomach or bent over with your arm hanging down, pull back onyour shoulder blade like you are pulling it to your opposite hip pocket. Maintainthis position while you lift your bent elbow towards the ceiling and then lower.Reps__________ Sets__________ Tempo__________



33 Sewall Street

Portland, ME 04102

(207) 828-2100


Shoulder blade push-upOn the ground either on your knees or on your toes with your hands in push-upposition. Pinch your shoulder blades together and then round out your backwhile focusing on the muscles between the shoulder blades and not tightening upinto the neck.Reps__________ Sets__________ Tempo__________

Serratus pressStand and face away from a cable pulley or theraband and hold it in your handout at shoulder height. Keeping your arm straight, press your shoulder bladeforward and then back while keeping tension out of your neck muscles.Reps__________ Sets__________ Tempo__________



33 Sewall Street

Portland, ME 04102

(207) 828-2100


Standing pull downsStand facing a cable pulley or theraband and hold it with both hands. Pull backon your shoulder blades and maintain this position while you lower your arms toyour side and then back up.Reps__________ Sets__________ Tempo__________

Standing rowsStand facing a cable pulley or theraband and hold it with both hands. Pull backon your shoulder blades and maintain this position while you pull the bandtowards you with both hands. Try not to let the elbows go much past the plane ofthe body. Progress to performing whileReps__________ Sets__________ Tempo__________



33 Sewall Street

Portland, ME 04102

(207) 828-2100


External rotationStanding with your side to a cable pulley or theraband, elbow bent 90 degreesand a towel roll under your arm. Pull back on shoulder blade and rotate arm outto the side in a pain-free range of motion and then back while maintaining goodshoulder blade retraction.Reps__________ Sets__________ Tempo__________

Internal rotationStanding with your side to a cable pulley or theraband, elbow bent 90 degreesand a towel roll under your arm. Pull back on shoulder blade and rotate the arminward towards the body and then back while maintaining good shoulder bladeretraction.Reps__________ Sets__________ Tempo__________



33 Sewall Street

Portland, ME 04102

(207) 828-2100


Bicep curlStanding and hold either a hand weight, cable pulley, or theraband in your handwith your palm facing up. Bend your elbow and lift the weight while maintaininggood shoulder blade postion and tight abdominals, then lower back to startingposition.Reps__________ Sets__________ Tempo__________

Triceps pressStanding facing a cable pulley or theraband and holding it with both hands withelbows bent. Pull back on shoulder blades and extend arms and then back up tobent position.Reps__________ Sets__________ Tempo__________



33 Sewall Street

Portland, ME 04102

(207) 828-2100


Scaption liftsStand with arms at your sides and your thumbs pointed out about 45 degrees.Pull back on your shoulder blades and the lift your arms out at an angle in a painfreerange of motion and as high as you can without hiking shoulder.Reps__________ Sets__________ Tempo__________

Seated 90-90 external rotationSit with your elbow bent 90 degrees and supported out to the side at shoulderheight or just below shoulder height. Pull back on shoulder blade and rotate thearm while maintaining the 90 degree bend of the elbow.Reps__________ Sets__________ Tempo__________

or tho associates - upper extremity protocols

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