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Instabilidade do Cotovelo

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Reabilitação após cirurgia para instabilidade do cotovelo, abrangendo tanto lesões laterais (tríade terrível / LCL) quanto lesões por arremesso (UCL medial), baseada em movimento precoce protegido em vez de imobilização.

Ilustração do cotovelo mostrando os ligamentos colaterais lateral e medial que estabilizam a articulação.
Os ligamentos colaterais nas faces externa (lateral) e interna (medial) do cotovelo, que são reparados ou protegidos após uma lesão de instabilidade. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Este protocolo orienta a sua recuperação após cirurgia para instabilidade do cotovelo com o Dr. Kieran Hirpara no Mater Private Hospital Rockhampton. Ele abrange dois tipos diferentes de instabilidade, e o seu cirurgião informará qual se aplica ao seu caso:

  • (A) Lesão lateral (lado externo): como uma lesão do "terceiro terrível" (terrible triad), uma luxação-fratura ou uma reparação do ligamento colateral lateral (LCL). Estas lesões são estabilizadas para que o cotovelo deixe de deslocar-se ou rodar fora do lugar.
  • (B) Lesão por arremesso (medial, lado interno): uma reparação ou reconstrução do ligamento colateral ulnar (UCL), geralmente em atletas que praticam lançamentos.

Todo o plano baseia-se numa ideia central: movimento precoce protegido, não imobilização. Períodos prolongados em gesso ou talas são a principal causa de um cotovelo permanentemente rígido, pelo que o objetivo é iniciar o movimento de forma segura e precoce. Traga esta página ou o seu PDF para a sua primeira sessão de fisioterapia para que a reabilitação seja coordenada. O seu fisioterapeuta pode ajustar o plano consoante a evolução da sua recuperação.

Se tiver alguma preocupação sobre a sua ferida cirúrgica após a operação, entre em contacto com a clínica. É frequentemente útil tirar uma fotografia da ferida e enviá-la por e-mail para avaliação.

O que esperar

O cotovelo é mantido no lugar por ligamentos nas faces medial e lateral da articulação. Quando estes são lesados (por luxação, luxação-fratura ou arremessos repetidos), a articulação pode tornar-se instável. A cirurgia repara ou reconstrói as estruturas danificadas para que a articulação volte a estar corretamente posicionada.

A abordagem do Dr. Hirpara evita o uso de uma órtese externa articulada volumosa. Se a reparação for estável em toda a amplitude de movimento no momento da cirurgia, utilizará apenas uma atadura leve para conforto e iniciará os movimentos do cotovelo precocemente, dentro de posições seguras. Se a estabilidade necessitar de maior proteção, pode ser colocada uma estabilizador articular interno no momento da cirurgia: uma pequena dobradiça interna que mantém o cotovelo corretamente reduzido por dentro, permitindo ainda assim a flexão e extensão precoces. Como a proteção é interna, evita-se ainda uma órtese externa que limite o arco de movimento. Se utilizada, este dispositivo interno é geralmente removido após a cicatrização dos ligamentos, por volta de quatro a seis meses.

Para o tratamento da ferida, edema e cicatriz, consulte as orientações da clínica sobre cuidados com a ferida.

O hábito mais importante nesta recuperação é manter o movimento dentro da sua amplitude segura, respeitando as posições que o seu cirurgião lhe pede para evitar. Os exercícios abaixo apresentados constituem o seu ponto de partida.

Precauções e limitações

As posições de proteção dependem do tipo de lesão que você tem. Seu cirurgião e terapeuta confirmarão as suas.

Para uma lesão lateral (lado externo) (tríade terrível / LCL):

  • Faça manter o antebraço virado palma para baixo (pronado) durante os movimentos; isso centraliza a articulação e protege o reparo lateral.
  • Faça exercícios com o braço à frente do corpo, ou deitado com o braço apontando para o teto, se solicitado, para que a gravidade ajude a manter a articulação estabilizada.
  • Não permita que o braço caia para o lado (evite abdução do ombro) nem suporte peso através dele nas fases iniciais; a gravidade, nesse caso, pode separar o reparo.
  • Não combine a extensão completa do cotovelo com o antebraço em pronação (palma para cima) até que seu cirurgião autorize (por volta de 16 semanas); esta é a posição em que a articulação pode voltar a subluxar.
  • Não empurre nem estique o cotovelo até a dor, e evite suporte de peso e cargas de impacto nos primeiros meses.

Para uma lesão por arremesso (medial, lado interno) (LUC):

  • Faça manter o antebraço em posição palma para cima (supinada) ou neutra, conforme orientado.
  • Não carregue o ombro em rotação externa nas fases iniciais; isso sobrecarrega o reparo medial. Isso geralmente é evitado até cerca de 6 semanas.

Seus exercícios

Estes são os exercícios do seu material didático, para recuperar o movimento seguro e manter a funcionalidade da mão, antebraço e ombro enquanto o cotovelo está protegido. Inicie-os e avance conforme orientado pelo Dr. Hirpara e seu terapeuta; a posição segura do antebraço e a amplitude de movimento dependem da sua lesão específica.

Seu protocolo clínico

O restante desta página é o protocolo clínico para seu fisioterapeuta ou terapeuta da mão. Ele está escrito em dois fluxos porque as duas lesões são protegidas de maneira diferente. Cada fase é regida por critérios: o progresso ocorre quando as metas são atingidas, e não simplesmente pelo calendário.

Antes do tratamento, verifique o raio-X do paciente, o laudo cirúrgico e o histórico médico, e entre em contato com o cirurgião assistente para discutir a estabilidade alcançada na cirurgia, o arco seguro e a rotação do antebraço, e se foi implantado um estabilizador articular interno. O Dr. Hirpara não utiliza órtese externa com dobradiça: uma reparação estável em amplitude completa é manejada com uma simples atadura (sling) e movimento precoce para conforto; onde a estabilidade precisa ser protegida, um estabilizador articular interno mantém a redução internamente enquanto permite a extensão até o conforto.

Track A — Tríade terrível / fratura-luxação / reparo do LCL (LUCL)

Objetivo: Um cotovelo estável, reduzido concentricamente, que se movimenta precocemente; prevenir a re-subluxação rotatória posterolateral.

Precauções essenciais durante toda a fase inicial:

  • Manter o antebraço em pronação para uma lesão lateral isolada (tensiona as estruturas laterais e posiciona a articulação radiocapitelar). Se ambas as colunas foram reparadas, manter o antebraço em neutro; a supinação é permitida apenas com o cotovelo flexionado a ~90°.
  • Evitar estresse em varo e abdução do ombro: a gravidade impõe uma carga em varo sobre o reparo lateral. Realizar amplitude de movimento ativa com o braço à frente do corpo, ou supino-sobre a cabeça (reduzido pela gravidade) se o reparo for delicado.
  • Sem extensão completa com supinação até ~16 semanas (reproduz o sinal de pivot-shift).
  • Sem apoio de peso / carga em cadeia fechada por 8–16 semanas.

Semanas 0–2: Movimento precoce. Tala simples para conforto. Iniciar amplitude de movimento ativa dos dedos, punho e ombro imediatamente. Iniciar amplitude de movimento ativa e ativa-assistida do cotovelo até o conforto a partir do dia 2–3, com o antebraço em pronação e o braço apoiado à frente do corpo (ou supino-sobre a cabeça se o reparo for delicado, de modo que a gravidade comprima a articulação). Quando um estabilizador articular interno está em posição, progredir para a extensão completa confortável precocemente; o dispositivo protege a redução; não é utilizada tala externa.

Semanas 2–6: Restaurar o arco. Progredir para flexão e extensão confortáveis completas (extensão até o conforto durante todo o período; um estabilizador interno, se presente, permite isso). Manter a inclinação para a pronação; evitar carga em varo. Critérios para progredir: arco passivo completo recuperado, sem re-subluxação no exame ou na radiografia, dor ≤3/10.

Semanas 6–12: Fortalecimento. Uma vez curado clinicamente e radiograficamente (~semana 6), iniciar fortalecimento progressivo; introduzir tala estática-progressiva se estiver se desenvolvendo uma contratura. Continuar a evitar carga em varo. Um estabilizador interno, se utilizado, geralmente é mantido até a cicatrização dos ligamentos.

Semanas 12–20+: Avançado / retorno. Resistência progressiva; retorno ao trabalho pesado. Esportes de contato e acima da cabeça em aproximadamente 6–9 meses (e após qualquer remoção do estabilizador interno). Continuar a evitar fortalecimento com carga em varo.

Rastreamento B — Reparação / reconstrução do LUC medial (lançamento)

Este é um problema crônico por sobrecarga no lado medial. A preferência do Dr. Hirpara é não utilizar órtese externa com dobradiça: a augmentação com internal-brace de fita de sutura (reparação) ou o enxerto tendinoso (reconstrução) fornecem a proteção, e a reabilitação é específica para o lançamento. O antebraço é posicionado preferencialmente em supinação/neutro; a rotação externa resistida do ombro é evitada até aproximadamente a semana 6, pois sobrecarrega o enxerto em valgo.

Reparação com augmentação de internal-brace (acelerada, compatível com a abordagem sem órtese externa):

  • Movimento precoce protegido até o conforto, semanas 0–4 (arco completo por volta da semana 6).
  • Programa Thrower's Ten a partir de aproximadamente a semana 3; pliometria a partir de aproximadamente a semana 6.
  • Programa de lançamentos intervalados a partir de aproximadamente a semana 11; retorno ao esporte por volta de 5–7 meses.

Rastreamento de reconstrução (enxerto), se utilizada (mais lento):

  • Arco completo por volta da semana 6; lançamentos intervalados nas semanas 14–16; lançamentos a partir de montículo não antes de 6 meses; retorno competitivo ao esporte tipicamente entre 9–16 meses.

Retornar ao trabalho e às atividades

A rapidez do seu retorno depende do tipo de lesão que sofreu e das exigências do seu trabalho ou desporto.

  • Lesão lateral (tríade terrível / LCL): tarefas leves de secretariado e de autocuidado podem ser retomadas precocemente, dentro das posições seguras. O fortalecimento geralmente inicia por volta das 6 semanas, após a consolidação clínica e radiográfica do cotovelo. Os desportos de contato e acima da cabeça são normalmente adiados para cerca de 6–9 meses, e após a remoção de um estabilizador articular interno, se tiver sido implantado. Evite apoiar peso no braço ou submetê-lo a cargas laterais até que o seu cirurgião o autorize.
  • Lesão por lançamento (LUC): com uma reparação reforçada por brace interno, um programa estruturado de lançamentos por intervalos geralmente inicia por volta das 11 semanas, com o retorno ao desporto em cerca de 5–7 meses. Após uma reconstrução, o retorno aos lançamentos competitivos é mais lento, geralmente entre 9–16 meses.

A condução é retomada quando tiver controlo confortável e seguro do braço fora da atadura e o seu cirurgião tiver confirmado que é adequado na consulta de seguimento. O seu terapeuta irá progredir o seu fortalecimento e os exercícios específicos para o desporto ou trabalho, em direção aos seus objetivos individuais.

Após o seu protocolo

Este protocolo complementa as orientações gerais de recuperação da clínica; consulte o manejo da dor pós-operatória e o cuidado com a ferida. A sua recuperação contínua é orientada individualmente pelo seu fisioterapeuta ou terapeuta da mão, de acordo com a evolução do seu cotovelo e com o tipo de lesão que sofreu. O resumo baseado em evidências para profissionais de saúde referente a este protocolo está disponível junto a esta página.

Reviewed by Dr Kieran Hirpara · 18 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Elbow Instability — Rehabilitation Evidence (Lateral / Terrible Triad / LCL and Throwing / UCL)

Topic scope: Post-operative rehabilitation after surgery for elbow instability, in two distinct tracks: (A) complex lateral instability — "terrible triad" / fracture-dislocation and lateral (ulnar) collateral ligament [LCL/LUCL] repair & reconstruction for posterolateral rotatory instability (PLRI); and (B) overhead-throwing ulnar (medial) collateral ligament [UCL] reconstruction & repair ("Tommy John").

Defining principle: the crux of every track is protected motion, not immobilisation. Restore enough stability to permit early range of motion (within ~1 week), because prolonged immobilisation is the dominant cause of disabling flexion contracture and stiffness. Dr Hirpara's stance: he does not use an external hinged brace. A repair that is stable through-range at surgery is managed with a simple sling for comfort plus early motion to comfort within positional precautions. Where stability needs protecting, he implants an internal joint stabiliser (an internal hinge) that holds the elbow reduced from the inside while permitting full flexion and extension to comfort — so the patient still moves early without an external arc-limiting brace. The device is typically removed once the ligaments have healed (~4–6 months). The published external-hinged-brace extension-block arcs below are retained as reference for what they represent biomechanically, not as Dr Hirpara's management.

(A) Terrible triad / complex fracture-dislocation / LCL (LUCL) repair & reconstruction

Forearm-rotation rule (the key precaution)

  • Lateral-sided (LCL/LUCL) injury → keep the forearm PRONATED. Pronation tightens the lateral structures and seats the radiocapitellar joint, protecting the lateral repair. Terminal extension is performed pronated; supination near full extension reproduces the pivot-shift and is avoided.
  • Medial-sided (MCL/UCL) injury → keep the forearm SUPINATED (Rockwood & Green; Green's Operative Hand Surgery).
  • If both columns are repaired (many terrible triads), the forearm is held neutral.
  • Early supination, when allowed, is done only with the elbow flexed to ~90° (flexion stabilises the ulnohumeral joint and protects the lateral reconstruction).

Phased timeline

  • Week 0–2 — Immediate post-op / early motion. Posterior splint at ~90° flexion in injury-appropriate forearm rotation for 7–14 days in the published protocols; the practical aim is early motion. Begin digit/wrist/shoulder AROM immediately and gentle elbow AROM/AAROM in the surgeon-defined stable arc within days (Brigham fracture-dislocation guideline starts elbow/forearm AROM at day 2–3). A supine/overhead protocol is an option where the lateral repair is tenuous — gravity compresses and stabilises the ulnohumeral joint (Green's; Lee 2013).
  • Week 2–6 — Protected motion / restore the arc. Published external-hinged-brace protocols open an extension block ~10°/week, forearm pronated (Denver/Eichinger: 30° at wk2 → 20° wk3 → 10° wk4 → 0° wk5), reaching full extension by ~week 5–6. Dr Hirpara replaces this external brace with a simple sling (through-range stable repair) or an internal joint stabiliser permitting extension to comfort. Precautions: avoid varus stress and shoulder abduction; avoid combined full-extension-with-supination for up to ~16 weeks; no weight-bearing/closed-chain for 8–16 weeks.
  • Week 6–12 — Intermediate / strengthening. Full PROM, joint mobilisations. Strengthening starts ~week 6 once clinical and radiographic healing is confirmed (Brigham PRE 6–8 wk; Rockwood & Green). Static-progressive splinting if a contracture is developing (Müller 2013).
  • Week 12–20+ — Advanced / return. Progressive resistance; avoid varus-loaded strengthening. Contact/overhead sport often delayed to ~6–9 months for reconstruction (Green's: unrestricted use ≥6 months for graft incorporation; Eichinger: up to 9 months).

Nonoperative (stable terrible triad) caveat: if the joint is concentrically reduced with a stable arc to ≥30° of extension (no radial-head block, small coronoid), nonoperative early-motion management is reasonable (Rockwood & Green / Chan criteria; Najd Mazhar 2017).

(B) UCL reconstruction / repair — throwing athlete ("Tommy John")

Rehabilitation is uniformly described in 4 phases (Brotzman-Wilk lineage; ASMI/Andrews; Mass General). The forearm is biased toward supination/neutral (medial-sided injury); no shoulder external-rotation loading early (it valgus-loads the graft).

  • Phase I — Week 0–3. Posterior splint at 90° week 1, then progressive ROM. Wrist AROM, gripping, submax shoulder isometrics (no ER), submax biceps isometrics from week 1–2.
  • Phase II — Week 4–6/8. Progress to full ROM by ~week 6. Light wrist/forearm strengthening, rotator-cuff isotonics; resisted shoulder ER avoided until ~week 6 to protect the graft.
  • Phase III — Week 6/9–12/13. Progressive elbow/forearm strengthening, eccentrics from ~wk9, Thrower's Ten, plyometrics ~wk9 if appropriate.
  • Phase IV — Week 14–26+. Interval throwing program ~week 14–16; long-toss ramp 45→60 ft, +30 ft increments to 180 ft; mound throwing ≥6 months; return to competitive throwing ~6 months for return-to-throw, but full competitive RTS typically 9–16 months (≥12 months a common criterion). ~83–97% RTS in throwers.

Internal-brace–augmented UCL REPAIR (accelerated track) — the recent shift

For acute/avulsion tears with good tissue, UCL repair with internal brace allows a markedly accelerated protocol (Dugas/ASMI; SLU/JOSPT 2019):

  • Mobilise early to comfort; full/unrestricted ROM by ~wk4, brace off by wk6.
  • Thrower's Ten from ~wk3; plyometrics from ~wk6.
  • Interval throwing as early as ~wk11; return to sport ~5–7 months (vs ≥9–12+ for reconstruction). Dugas 2025 (AJSM) head-to-head: repair ~2–3 weeks accelerated for ROM/strengthening and ~5–9 weeks accelerated for starting the interval throwing program, with comparable outcomes in appropriately selected athletes.

Phased-timeline summary

Phase / window Track A — lateral (terrible triad / LCL) Track B — throwing (UCL, internal-brace repair)
Weeks 0–2 Sling for comfort; elbow AROM/AAROM to comfort from day 2–3, forearm pronated, arm supported in front / supine-overhead Early protected motion to comfort; submax shoulder (no ER) + biceps isometrics; grip/wrist work
Weeks 2–6 Restore full comfortable arc; extension to comfort (internal stabiliser permits); maintain pronation, avoid varus Progress to full arc by ~wk6; Thrower's Ten from ~wk3
Weeks 6–12 Strengthening once healed (~wk6); static-progressive splint if contracture Plyometrics from ~wk6; progressive strengthening
Weeks 12–20+ Progressive resistance; contact/overhead sport ~6–9 mo Interval throwing ~wk11; RTS ~5–7 mo (reconstruction: 9–16 mo)

Key controversies

  1. Early vs protected motion (complex instability). Strong consensus favours early motion (≤7 days), BUT the two 2024 systematic reviews (Ahmed Kamel, JSES; Larwa, Shoulder & Elbow) found no RCT and high heterogeneity (immobilisation 1–76 days, weighted mean ~42–47). "Early" is biomechanically favoured, not Level-I proven; over-aggressive motion risks re-subluxation in a marginally stable repair.
  2. Brace necessity & utility. A hinged orthosis is the published standard, but Manocha/King (JHS 2018) showed it adds little stability with the arm overhead (gravity already compresses the joint), supporting overhead/supine rehab over brace reliance for lateral injuries (Lee 2013). This underpins Dr Hirpara's no-external-brace approach.
  3. Forearm-rotation dogma. Pronation-for-lateral / supination-for-medial is biomechanically grounded and widely taught, but Selley 2025 found forearm rotation at graft tensioning did not change postoperative medial gapping — questioning how rigidly rotation must be controlled in UCL cases.
  4. Accelerated vs conservative UCL return-to-throw. Time-to-RTS varies 4–16 months with no consensus threshold; Erickson 2017 found earlier RTS did not raise revision risk in MLB pitchers, undercutting strict "wait ≥12 months" dogma.
  5. Internal brace enabling faster rehab. The biggest recent shift: suture-tape/internal-brace augmentation gives superior time-zero biomechanics and supports repair (not reconstruction) in selected throwers with a 5–9-week-faster throwing timeline. Durability in elite pitchers and mid-substance tears is still maturing (Level III–IV).

Evidence strength flags

  • (A) Complex instability / LCL: LOW–MODERATE. No RCTs; guidance is biomechanical + expert-consensus + Level III/IV case series and two 2024 systematic reviews. Internal-joint-stabiliser data (Orbay/Mighell lineage; Dunning/Morrey biomechanics) are device-specific case series — Consensus / Moderate.
  • (B) UCL throwing: MODERATE. Large case series, multiple systematic reviews, and concordant institution-standard protocols (Brigham/Brotzman-Wilk, Mass General, ASMI/Andrews) for the phased arc and interval-throwing timeline. Internal-brace augmentation is newer (Level III–IV, growing).
  • Rehabilitation protocols themselves: CONSENSUS / WEAK — phase timings derive from published institutional protocols, not rehab RCTs.

Citations

RAG corpus (180,000+ Orthopaedic articles)

  • Szekeres M, Chinchalkar SJ, King GJ. Optimizing Elbow Rehabilitation After Instability. Hand Clin. 2008.
  • Wilk KE, Arrigo CA. Rehabilitation of Elbow Injuries. Clin Sports Med. 2020.
  • Ahmed Kamel S, Shepherd J, Al-Shahwani A, et al. Postoperative mobilization after terrible triad injury: systematic review and single-arm meta-analysis. J Shoulder Elbow Surg. 2024;33(3):e116–e125.
  • Larwa J, Buchanan TR, Janke RL, et al. Characteristics of rehabilitation protocols following operative treatment of terrible triad elbow injuries and the influence of early motion: systematic review and meta-analysis. Shoulder Elbow. 2024.
  • Najd Mazhar F, Jafari D, Mirzaei A. Evaluation of functional outcome after nonsurgical management of terrible triad injuries of the elbow. J Shoulder Elbow Surg. 2017;26(8):1342–1347.
  • Manocha RH, King GJ, Johnson JA. In Vitro Kinematic Assessment of a Hinged Elbow Orthosis Following Lateral Collateral Ligament Injury. J Hand Surg Am. 2018.
  • Lee AT, Schrumpf MA, Choi D, et al. The influence of gravity on the unstable elbow. J Shoulder Elbow Surg. 2013;22(1).
  • Dunning CE, et al. (Morrey lineage). Ligamentous Repair and Reconstruction for Posterolateral Rotatory Instability of the Elbow. 2006. (LCL/LUCL stabiliser biomechanics.)
  • Müller AM, Sadoghi P, Lucas R, et al. Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: systematic review/meta-analysis of 13 studies. J Shoulder Elbow Surg. 2013. (Static-progressive stretch for stiffness.)
  • Selley RS, Lawton CD, Owusu-Akyaw K, et al. Forearm Rotation at the Time of Elbow UCL Reconstruction Graft Tensioning Does Not Affect Postoperative Medial Elbow Joint Gapping. Orthop J Sports Med. 2025.
  • Erickson BJ, Cvetanovich GL, Frank RM, et al. Do Clinical Results and RTS Rates After UCL Reconstruction Differ Based on Graft Choice and Surgical Technique? Orthop J Sports Med. 2016.
  • Erickson BJ, Chalmers PN, Bach BR, et al. Length of time between surgery and RTS after UCL reconstruction in MLB pitchers does not predict need for revision. J Shoulder Elbow Surg. 2017.
  • Kemler BR, Rao S, Willier DP, et al. Rehabilitation and Return to Sport Criteria Following UCL Reconstruction: A Systematic Review. Am J Sports Med. 2021.
  • Griffith R, Bolia IK, Fretes N, et al. RTS Criteria After Upper Extremity Surgery, Part 2: UCL of the Elbow. Orthop J Sports Med. 2021.
  • Dugas JR, Froom RJ, Mussell EA, et al. Clinical Outcomes of UCL Repair With Internal Brace Versus UCL Reconstruction in Competitive Athletes. Am J Sports Med. 2025.
  • Dugas JR, Looze CA, Capogna B, et al. UCL Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes. Am J Sports Med. 2019;47(5).
  • Jackson GR, Opara O, Tuthill T, et al. Suture Augmentation in Orthopaedic Surgery Offers Improved Time-Zero Biomechanics and Promising Short-Term Clinical Outcomes. Arthroscopy. 2023.
  • Cain EL, Dugas JR, Wolf RS, et al. Elbow Injuries in Throwing Athletes: A Current Concepts Review. Am J Sports Med. 2003.
  • Erickson BJ, Bach BR, Verma NN, et al. Treatment of Ulnar Collateral Ligament Tears of the Elbow. Orthop J Sports Med. 2017.
  • Rockwood and Green's Fractures in Adults. 2019. — long-arm splint 7–10 d; lateral injury → forearm pronated, medial → supinated; avoid shoulder abduction/varus for lateral injury; strengthening ~6 wk.
  • Green's Operative Hand Surgery. 2021. — supination only with elbow maximally flexed; overhead/supine protocol option; isometric strengthening 8–10 wk; unrestricted use ≥6 mo.

Published protocols (literature URLs)

  • Brigham & Women's Hospital — Elbow Fracture/Dislocation Post-Op ORIF Hand Therapy Guideline (2021). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-fracture-orif-hand-therapy-protocol.pdf
  • Brigham & Women's Hospital — UCL of the Elbow Reconstruction Using Autogenous Graft Protocol (Brotzman-Wilk modification). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-ulnar-collateral-ligament-reconstruction-protocol-bwh.pdf
  • Massachusetts General Hospital Sports Medicine — Rehabilitation Protocol for UCL Reconstruction (rev. Nov 2018). https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-UCL.pdf
  • Saint Louis University Sports Medicine / JOSPT 2019 — Rehabilitation s/p UCL Repair with Internal Brace. https://www.slu.edu/medicine/orthopaedic-surgery/sports-medicine/-pdf/ucl-repair-guidelines-final.pdf
  • Eichinger MD — Rehabilitation Guidelines for Elbow Lateral Collateral Ligament Repair (2018). https://www.josefeichingermd.com/pdf/rehab-for-lateral-collateral-ligament-repair-3-4-18.pdf
  • Denver Shoulder — Rehabilitation Protocol: Lateral Collateral Ligament Repair (extension block 30°→20°→10°→0° wk2–5, forearm pronated; supination only at 90° flexion). https://www.denvershouldersurgeon.com/pdf/lcl-repair-protocol.pdf
  • Orthopaedic Medical Group of Tampa Bay — Elbow Dislocation Rehab Protocol. https://www.omgtb.com/wp-content/uploads/pdfs/elbow-dislocation-rehab.pdf

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.