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 a
fracture at the elbow, including fractures to the distal humerus and/or proximal ulna, with
subsequent surgery for internal fixation. It is important for the therapist to be in contact
with 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 of
fracture.

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

* Depending on the patient’s condition, frequency of Physical Therapy will be decided

on an individual basis.
 33 Sewall Street
Portland, ME 04102
(207) 828-2100

www.orthoassociates.com

UPPER EXTREMITY STRENGTHENING EXERCISES

Prone extension
Lying on your stomach or bent over with your arm hanging down, pull back on
your shoulder blade like you are pulling it to your opposite hip pocket. Maintain
this position while you lift your straight arm up to the level of your hip and then
lower.
Reps__________ Sets__________ Tempo__________

Prone row
Lying on your stomach or bent over with your arm hanging down, pull back on
your shoulder blade like you are pulling it to your opposite hip pocket. Maintain
this 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

www.orthoassociates.com

Shoulder blade push-up

On the ground either on your knees or on your toes with your hands in push-up
position. Pinch your shoulder blades together and then round out your back
while focusing on the muscles between the shoulder blades and not tightening up
into the neck.
Reps__________ Sets__________ Tempo__________

Serratus press
Stand and face away from a cable pulley or theraband and hold it in your hand
out at shoulder height. Keeping your arm straight, press your shoulder blade
forward and then back while keeping tension out of your neck muscles.
Reps__________ Sets__________ Tempo__________
 33 Sewall Street
Portland, ME 04102
(207) 828-2100

www.orthoassociates.com

Standing pull downs

Stand facing a cable pulley or theraband and hold it with both hands. Pull back
on your shoulder blades and maintain this position while you lower your arms to
your side and then back up.
Reps__________ Sets__________ Tempo__________

Standing rows
Stand facing a cable pulley or theraband and hold it with both hands. Pull back
on your shoulder blades and maintain this position while you pull the band
towards you with both hands. Try not to let the elbows go much past the plane of
the body. Progress to performing while
Reps__________ Sets__________ Tempo__________
 33 Sewall Street
Portland, ME 04102
(207) 828-2100

www.orthoassociates.com

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

Internal rotation
Standing with your side to a cable pulley or theraband, elbow bent 90 degrees
and a towel roll under your arm. Pull back on shoulder blade and rotate the arm
inward towards the body and then back while maintaining good shoulder blade
retraction.
Reps__________ Sets__________ Tempo__________
 33 Sewall Street
Portland, ME 04102
(207) 828-2100

www.orthoassociates.com

Bicep curl
Standing and hold either a hand weight, cable pulley, or theraband in your hand
with your palm facing up. Bend your elbow and lift the weight while maintaining
good shoulder blade postion and tight abdominals, then lower back to starting
position.
Reps__________ Sets__________ Tempo__________

Triceps press
Standing facing a cable pulley or theraband and holding it with both hands with
elbows bent. Pull back on shoulder blades and extend arms and then back up to
bent position.
Reps__________ Sets__________ Tempo__________
 33 Sewall Street
Portland, ME 04102
(207) 828-2100

www.orthoassociates.com

Scaption lifts
Stand 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 painfree
range of motion and as high as you can without hiking shoulder.
Reps__________ Sets__________ Tempo__________

Seated 90-90 external rotation

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