Work and Activity Restrictions
• 0–2 weeks: No work, no use of operative hand
• 2–6 weeks: Discontinue sling and begin formal physical therapy; okay to use hand for activities of daily living (ADLs); nothing in the operative hand heavier than a fork, knife, or toothbrush
• 6 weeks–3 months: Less than 5 lb weight bearing in operative hand; cleared to return to work for opposite-hand-only tasks
• 3 months+: No restrictions
0–2 Weeks: Wound Rest
• Sling at all times except when performing elbow, wrist, and hand exercises (flexing and extending the hand, wrist, and elbow) and for hygiene purposes
• Perform elbow, wrist, and hand exercises 3–5 times per day
2–6 Weeks: Regain Range of Motion
• Discontinue sling
• Begin physical therapy with JPL Exercises Phase I
– Transition to Phase II of JPL Exercises when comfortable with Phase I
– Transition to Phase III of JPL Exercises when comfortable with Phase II
– Begin passive range of motion in external rotation and flexion (consider a towel or bump under the elbow for supine external rotation to avoid shoulder extension)
• Perform 3–5 sets of JPL exercises per day, 5 repetitions per set
• Stretching routine should be done 3–5 times per day
6 Weeks–3 Months: Regain ROM and Begin Strengthening
• Continue formal physical therapy
– If a warm pool is available, begin pool exercises
• No motion restrictions
• 5 lb weight limit on the operative side
• Begin internal rotation stretch:
– Patient extends lumbar spine and allows operative arm to hang toward the floor, clearing buttocks
– Once in position, bring operative hand to lumbar spine
– Expect anterior tightness for 3–4 weeks before loosening occurs
• Begin rope and pulley exercises and table slides for terminal passive elevation
• Begin gentle strengthening exercises with theraband: external rotation, low row, anterior deltoid
• Internal rotation stretching: cross-body stretch and up-the-back stretch with towel
3 Months+: Strengthening
• Weight bearing as tolerated
• No range-of-motion restrictions
