Results And Expectations

Athletes who have isolated posterior compartment lesions usually return to their premorbid level of competition. At our clinic, we have found that 71% of athletes

FIGURE 10.7. Intraoperative lateral radiograph of the elbow after arthroscopic excision of the osteophyte.

TABLE 10.1. Postoperative rehabilitative protocol for elbow arthroscopy.

I. Initial phase (week 1)

Goal: Full wrist and elbow ROM, decrease swelling, decrease pain, retardation of muscle atrophy

A. Day of surgery

1. Begin gently moving elbow in bulky dressing

B. Postoperative days 1 and 2

1. Remove bulky dressing; replace with elastic bandages

2. Immediate postoperative hand, wrist, and elbow exercises a. Putty/grip strengthening b. Wrist flexor stretching c. Wrist extensor stretching d. Wrist curls e. Reverse wrist curls f. Neutral wrist curls g. Pronation/supination h. A/AAROM elbow extension/flexion

C. Postoperative days 3 through 7

1. PROM elbow extension/flexion (motion to tolerance)

2. Begin PRE exercises with 1-lb weight a. Wrist curls b. Reverse wrist curls c. Neutral wrist curls d. Pronation/supination e. Broomstick roll-up

II. Intermediate phase (weeks 2 through 4)

Goal: Improve muscular strength and endurance; normalize joint arthrokinematics

A. Week 2 ROM exercises (overpressure into extension)

1. Addition to biceps curl and triceps extension

2. Continue to progress PRE weight and repetitions as tolerable

1. Initiate biceps and triceps eccentric exercise program

2. Initiate rotator cuff exercise program a. External rotators b. Internal rotators c. Deltoid d. Supraspinatus e. Scapulothoracic strengthening

III. Advanced phase (weeks 4 through 8)

Goal: Preparation of athlete for return to functional activities

Criteria to progress to advanced phase:

1. Full nonpainful ROM

2. No pain or tenderness

3. Isokinetic test that fulfills criteria to throw

4. Satisfactory clinical exam A. 3 through 6 weeks

1. Continue maintenance program, emphasizing muscular strength, endurance, and flexibility

2. Initiate interval-throwing program phase I

Used with permission from Wilk KE, Azar FM, and Andrews JR.21

ROM, range of motion; AAROM, active-assistive range of motion; PROM, passive range of motion; PRE, passive resistance exercise.

returned to participation at the same or higher level of competition for an average of 3.3 years. Patients should be counseled that this procedure is palliative, and recurrence of osteophytes or increased symptoms of instability may occur. Recently, questions have been raised regarding the possible stabilizing effect of the posteromedial osteophyte. Underlying incompetence of the UCL may be partially responsible for the development of the posteromedial osteophyte, and resection of the osteo-phyte may lead to increased stress on the ligament. Some patients may require subsequent reconstruction of the UCL. A recent follow-up study3 showed that the rate of revision elbow surgery was about 30% in professional baseball pitchers. Fifteen percent of these patients needed repeat osteophyte excision, and 15% needed UCL reconstruction. Patients who have revision elbow surgery have about a 50% chance of returning to their previous level of competition.

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