Rehabilitation after Paediatric Elbow Injuries and Fracture Surgery

Rehabilitation after paediatric elbow fracture treatment is essential for regaining full function, strength, and range of motion in the elbow joint. Recovery varies depending on the type and severity of the fracture, the surgical procedure used, and the child’s age and healing rate. In general, most young children recover well without going through a formal rehabilitation protocol as it is uncommon for young children to develop joint stiffness as compared to adults.  In the older child (adolescents and teenagers), formal rehabilitation may be required for a speedy return to full joint motion and function.  This article outlines the main steps in elbow post-surgery rehabilitation, highlighting important factors for parents and caregivers to consider.

1. Key Goals in Rehabilitation

The goals of rehabilitation for paediatric elbow fracture generally include:

• Restoring Range of Motion (ROM) – Injuries around the joint can cause stiffness, this is especially so after 3-4 weeks of joint immobilisation in a plaster cast.  When the limb first comes out of the cast, stiffness is a common feature and is expected, so improving movement is the primary focus.
• Strengthening Muscles – Periods of joint immobilisation weaken muscles around the elbow, which require gradual strengthening.

2. Phases of Rehabilitation

Paediatric elbow rehabilitation is usually broken down into three main phases:

Early Phase: Immobilisation and Pain Control

After surgery, the child’s elbow will typically be immobilised in a splint or cast for a few weeks. The orthopaedic surgeon will guide the timing and method of immobilisation, depending on the specific elbow injury.

Key objectives during this phase include:

• Minimising Pain and Swelling – Gentle movements of the wrist and fingers, icing, and prescribed pain medication can help control discomfort.
• Preparing for Movement – Simple hand and finger exercises can improve circulation and maintain some activity during immobilisation.

Middle Phase: Restoring Range of Motion (ROM)

Once the orthopaedic surgeon confirms that the bones are stable, the next phase involves gently increasing movement. A physiotherapist may introduce:

• Passive and Active ROM Exercises – Exercises that begin with gentle, guided movements to encourage elbow flexion and extension.

• Gradual Load Bearing – Slowly incorporating light loads and gentle stretching to encourage muscle strength while avoiding strain on the joint.

Final Phase: Strengthening and Functional Training

Starts: Usually around 6-8 weeks post-surgery, after bone healing is confirmed through X-rays.

Goal: To restore muscle strength and joint stability, and to support functional movements.

Approach:

• Isometric exercises: These exercises focus on muscle activation without joint movement to build initial strength without stressing the joint.
• Progressive resistance training: Light resistance exercises using bands or weights may be introduced gradually as the child gains strength and stability.

Other Activities: Grip-strength exercises may also be included to rebuild strength in the forearm, as extended immobilization can lead to weakness in surrounding muscles.

Functional Recovery Phase

Starts: Around 8-12 weeks or longer, depending on the complexity of the fracture and surgery.

Goal: To restore full range of motion, strength, and return to normal activities.

Approach: Exercises become more dynamic, focusing on simulating daily activities and sports-specific movements (if applicable). Activities might include:

• Functional ROM exercises: Movements that mimic daily activities like eating, dressing, and writing.
• Advanced strengthening and proprioceptive exercises: These may involve resistance bands, light weights, or bodyweight exercises to improve strength, balance, and coordination.
• Sport-specific drills: For children involved in sports, functional movements related to their activity may be practiced toward the end of rehab.

Return to Activity Phase

Timeline: Varies widely, but most children can return to light activity within 3-4 months and sports within 4-6 months, depending on healing and rehab progress.

Goal: A safe return to daily activities, sports, and play.

Evaluation: The physical therapist and orthopaedic surgeon will assess the child’s recovery, including strength, stability, and range of motion, before clearing them for full activity.

3. Additional Tips for Rehabilitation:

• Consistency with Therapy: Regular attendance at therapy sessions and doing prescribed home exercises is crucial.
• Pain Management: Swelling or discomfort may occur after starting exercises. Ice, elevation, and any prescribed pain medication can help manage symptoms.
• Parental Support: Encouraging the child to complete exercises and maintain a positive mindset is important for progress.

4. Role of Parents and Caregivers

Parents and caregivers play a significant role in the success of the rehabilitation process. Here are some tips:

• Encourage Consistent Exercises – Ensure the child follows prescribed exercises and attends all physiotherapy sessions.
• Observe Pain Levels – Pay attention to signs of pain, swelling, or discomfort and communicate these to the orthopaedic surgeon or physiotherapist.
• Provide Emotional Support – Children may feel nervous about movement or experience frustration. Support their progress and remind them that recovery takes time.

5. Monitoring Progress and Follow-Up Appointments

Regular check-ups with the orthopaedic surgeon are essential to track the child’s recovery. During these visits, the surgeon will assess:

• Healing progress through physical examinations and possibly imaging (e.g., X-rays).
• Adjustments needed in the rehabilitation plan based on ROM, strength, and any discomfort.

6. Preventing Re-Injury

Once rehabilitation is complete, it’s essential to take preventive measures to reduce the risk of future injuries, such as:

• Avoiding Early High-Impact Activities – Gradually reintroduce physical activities as recommended
• Strengthening Surrounding Muscles – Stronger muscles can provide better support to the elbow joint and help prevent injuries.

7. Potential Challenges:

• Stiffness and Limited Range of Motion: Elbow stiffness is common after immobilization, and consistent, gradual exercises are key to overcoming it.
• Growth Plate Concerns: In some cases, growth plates are affected, requiring close monitoring by the orthopaedic specialist.

In summary, the goal of paediatric elbow surgery rehabilitation is a gradual return to normal activities through careful strengthening, mobility work, and regular monitoring.

Conclusion

Rehabilitation is a critical part of the healing journey after paediatric elbow surgery. Working closely with the orthopaedic surgeon and physiotherapist ensures that recovery is as smooth and effective as possible. With careful attention and guided exercises, children can regain full function of the elbow joint and resume their regular activities safely.

For more information or to schedule an appointment with Dr. Maria Wong, please visit drmariawong.com and take the first step towards improving your child’s musculoskeletal health.