Coonrad–Morrey total elbow arthroplasty — rehabilitation protocol

Before exercises start, confirm the implant, primary or revision procedure, triceps management, bone and implant stability, any fracture or fixation, ulnar nerve procedure and wound condition. Discharge instructions should specify permitted movements, flexion limits, splint use and review arrangements.

A posterior approach does not necessarily mean an intact triceps insertion. If the operative details are incomplete, agree the programme with the orthopaedic surgeon before introducing active extension or increasing flexion. Early motion is determined by tissue status, not the implant name alone. ^[2]

Intact insertion — triceps-on / preserving approach

With the surgeon’s approval, early active and assisted movement may be possible within wound and pain tolerance. Preserving the insertion does not remove implant loading restrictions. ^[2]

Detached and reattached insertion — triceps-off

Protective option for individual approval: approximately the first 6 weeks, passive or assisted extension without triceps contraction; no independent active extension against the weight of the forearm unless specifically authorised by the surgeon. Flexion remains within the range safe for the repair and skin, without a universal angle target. Avoid triceps isometrics, band extension and weight-bearing.

At approximately 6 weeks, the surgeon assesses healing and decides whether active extension without additional resistance can begin. Poor tissue quality may require longer protection. This timing is a proposed clinical framework, not automatic clearance. Permission for active movement is not permission for strength training.

Goals: protect the wound, manage pain and swelling and learn safe daily tasks. A sling provides support and comfort; a prescribed splint protects the tissues according to the surgeon’s instructions. Do not independently change its angle or discontinue it.

Support the forearm and hand on a soft surface without pressure over the posterior or medial elbow. Gently move the fingers and wrist without forceful ball squeezing. Support the operated limb during shoulder movements. Begin elbow exercises when authorised by the surgical team. Do not exercise independently while a nerve block remains active.

Proposed initial dose: 5–10 gentle repetitions of permitted movements in 3–5 short sessions daily, adjusted by the physiotherapist to the joint response. Instruction before discharge or in the first days afterwards; subsequent visits according to independence and progress. Wound review follows the discharge plan, often around days 10–14.

Progression criteria: uncomplicated wound healing, decreasing swelling, controlled pain and correct technique. Bleeding, discharge or wound separation warrants contact with the team.

Continue permitted flexion, the type of extension appropriate to the approach, and forearm rotation. Do not force full extension or maximum flexion. The priority is function while tissues heal, without a mandatory angle at a particular week.

Rotate the forearm with the elbow near the trunk, without weight or resisted twisting. Introduce light self-care only within the prescribed limits. Do not force open jars, carry shopping, lift a kettle or push heavy doors with the operated arm.

The physiotherapist records motion, pain, swelling, hand function and sensation. Progressive motion loss requires reassessment, not stronger stretching. Splints intended to improve motion may be considered only after surgical review.

Following clinical and imaging review as planned by the surgeon, progress active movement and light tasks. After triceps reattachment, begin movement without added resistance under conditions selected by the physiotherapist. Increasing active extension lag or sudden weakness requires stopping progression and contacting the surgeon.

The lifting restriction below applies throughout the first 3 months. Do not routinely introduce dumbbells, resistance bands or exercises against the other hand. Thereafter, comfortable motion and light daily function remain the goals.

Return to work depends on actual duties. Desk work requires arm support and breaks. Heavy manual work may remain unsuitable permanently. Driving requires discontinuation of immobilisation and impairing medicines, the ability to perform an emergency manoeuvre safely, and agreement with the treating clinician.