Suggested Home Maintenance for the Postsurgical Patient 10-1

Maxey: Rehabilitation for the Postsurgical Orthopedic

Chapter 10: Clinical Applications for Platelet RichPlasma Therapy

Suggested Home Maintenance Program Post-UCL PRP Injection

Weeks 1 to 2:

No strengthening, no activity, gentle passive range of motion (PROM) only

Treatment: Avoid all valgus stressing activities/exercises × 4 weeks

Modalities (ice)

Isometric elbow strengthening (BID): inner- to mid-range submaximal holds

HEP (rest, heat, passive to light active motion, no resistance exercises or loading)

ROM emphasis: passive to light active ROM

Week 2:

Begin active range of motion (AROM) exercise elbow flexion, extension, and wrist; all planes within pain-free range (no weights or stretching)

Week 3:

Avoid valgus loading (resistance shoulder internal rotation) or ligament stretching

Maintain glenohumeral flexibility (HBB towel, glenohumeral flexion doorway stretching, sleeper stretch)

Elbow flexion, extension (supinated grip to decrease UCL load), supination (3 sets, 20 reps)

Wrist flexion, extension, radial deviation, ulnar deviation (3 sets, 20 reps)

Flexion, scaption, speeds with pulleys/free weights

Scapular mid and low rows

Closed kinetic chain (CKC) weight shifting (elbows unlocked); upright scapular pluses against wall

Start emphasizing biceps, pronator teres, and flexor carpi ulnaris (FCU) group concentrics to support medial elbow

Shoulder exercises to be performed with physical therapy in the clinic to ensure proper technique

Weeks 4 to 6:

Add/begin functional diagonal and proprioceptive neuromuscular facilitation (PNF) patterns

Initiate elbow, wrist, and hand resistance exercises. Begin with concentrics in controlled ranges, light tubing with chest press, and rows (3 sets, 15 to 20 reps)

Add more scapular strengthening progressions (lawn mower pulls, cross hearts, depressions, Kibler scapular exercises)

Scapular pluses and standing wall push-ups, or counterweighted (shuttle) scapular protractions

Ball ER rolls against wall

†Start inner- to mid-range glenohumeral IR (3 sets, 15 reps)

ER side-lying or pulleys progress to mid- and outer-range planes @ 90/90

Early CKC exercises (quadruped weight shifting, alternate arm/leg lifts, scapular pluses)

Continue scapular strengthening progressions; add barrel hugs, modified push-ups on hands, knees

Weeks 6 to 8:

Progress to fast twitch and dynamic exercises (nonthrowing medicine ball and tubing)

Increase speed and functional strengthening phase III to IV progressions

Continue all earlier phase exercise

Add towel throws if no pain with UCL stress tests; focus on head/trunk position, balance and alignment

Weeks 8 to 10:

Pending follow-up US imaging findings progress to return to play phase IV exercises

May begin controlled overhead return to sport activities (simulated towel drill, shadow drills, controlled plyometric pulley patterns, increased speed with mid- to outer-range exercises, progress to two-hand throwing with lighter weight medicine ball/rebounder drills); CKC progression including walkouts, step overs

Isokinetic strengthening

Weeks 10 to 12:

Progress to 50% to 75% of activity effort (short toss, long toss). Begin interval return to sport/throwing program (Chapter 13). Start interval throwing, batting, tennis serve, volleyball hitting programs pending repeat US imaging findings, objective examination results, functional testing, and subjective functional tool score

Cuff strengthening: outer ranges, ballistics, speed pulley patterns; inner range: slide board/fitter drills for valgus loading

Rebounder progressions (two-hand chest pass, overhead throw ins, shot puts, single overhead throws, eccentrics)

CKC plyometrics

Weeks 10 to 12:

Progress from 75% to 90% in controlled setting

Weeks 12 to 14:

Gradual return to sport

Overlap of timelines is based on the patient’s condition and severity of injury