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发表于 16-5-2009 10:55 PM
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REHABILITATION FOR OPERATIVE RADIAL HEAD FRACTURES
Preoperative Rehabilitation
• Injury is protected with immobilization through casting, splinting and/or placed in a sling
• Patient is instructed of post-operative rehabilitation goals and plan
Immobilization: (3-5 days post op)
Goals: Control pain and edema
Protect fracture site with posterior splint or compression bandage
Minimize cardiovascular deconditioning
Maintain range in joints around the effected region (shoulder, wrist, and fingers)
Prevent contractures
Patient can don/doff sling independently with elbow at 90 degrees flexion with forearm
in neutral
Cuong Pho DPT, Joe Godges DPT Loma Linda U DPT Program KPSoCal Ortho PT Residency
5
Intervention:
• Modalities, such as TENS and ice, for pain control
• Splint/Sling as direct by MD
• Monitor use and weight bearing instructions per MD
• Cardiovascular conditioning
• Gentle range of motion exercises of the shoulder, wrist, and fingers
• Passive flexion/extension of the elbow
• Passive pronation/supination of the elbow
Phase I maximum protection phase: (7 days - 3 weeks post op)
Goals: Continue to control pain and edema as needed
Minimize deconditioning
Regain range of motion within pain limits
Prevent muscle atrophy
Intervention:
• Active assistive flexion/extension with stick or pulleys
• Active assistive pronation/supination with stick or pulleys
• Cardiovascular conditioning
• Increase mobility to tolerance, prevent stiffness
• CPM
Phase II moderate protection phase: (4-6 weeks post op)
Goals: Regain full range of motion
Actively work within newly gained range of motion
Increase strength
Intervention:
• Active flexion/extension of the elbow
• Active pronation/supination of the elbow
• Active: flexion, extension, pronation, supination with a wand or pulleys
• Pulleys with eccentric control during flexion/extension
• Isometrics: flexion, extension, pronation, supination
• Gentle stretching using inhibition/elongation techniques or joint mobilization to increase
range of motion
Cuong Pho DPT, Joe Godges DPT Loma Linda U DPT Program KPSoCal Ortho PT Residency
6
Phase III minimum protection phase: (12 weeks post op)
Goals: Increase strength (especially at end ranges)
Educate patient on proper joint protection and therapeutic exercises
Gain adequate strength in the forearm flexors and extensors to increase stability at the
elbow
Strengthen the elbow flexors and extensors to gain full range of motion
Increase speed and control of limb movement
Intervention:
• Resistive exercises: standing with weights, theraband resisted (flexion, extension,
pronation, supination) exercises
• Self-stretching: flexion/extension, pronation/supination, shoulder flexion/extension, and
wrist flexion/extension, ulnar deviation / radial deviation
• Advance elbow extension with radial deviation and elbow flexion with ulnar deviation
• Higher speed and high intensity isotonic flexion/extension, pronation/supination while
standing or performing ADLs
• Incorporate open and closed-chain exercises |
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