Common Flexor Tendon Repair Protocol (Golfer's Elbow Surgery)

This protocol provides guidelines for rehabilitation following a Common Flexor Tendon Repair (Golfer's Elbow Surgery). The goal of surgery is to debride chronic, degenerative tissue and reattach the healthy common flexor tendon to the medial epicondyle. A structured, phased rehabilitation program is critical to protect the repair while gradually restoring range of motion, strength, and function of the elbow, wrist, and forearm.

Phase I: Immediate Post-Operative Phase (Weeks 0 - 2)

The primary focus of this phase is protecting the surgical repair, managing pain and swelling, and maintaining mobility in the non-involved joints.

• Goals: Protect the healing tendon repair; control pain and swelling; maintain full range of motion in fingers, shoulder, and cervical spine; promote healing of the incision.
• Precautions & Restrictions: Wear the post-operative splint or brace as directed by your surgeon (typically fixed at 90 degrees of flexion with the forearm in a neutral position); no active wrist flexion; no active forearm pronation; avoid sudden, jerking movements; strictly no lifting or weight-bearing on the affected arm.
• Suggested Exercises: Active finger flexion and extension (making a fist and opening hand); active range of motion for the shoulder and neck (to prevent stiffness); active elbow range of motion if allowed by the surgeon (usually passive or active-assisted flexion within a restricted range, avoiding terminal extension); gentle passive wrist extension to neutral (do not stretch into extreme extension).
• Criteria to Progress: Incision is healing cleanly with no signs of infection; minimal pain and swelling; full active range of motion of the fingers.

Phase II: Early Protection and Active Range of Motion (Weeks 2 - 6)

During this phase, the tendon continues to heal, and we gradually introduce active movement of the elbow and wrist without resistance.

• Goals: Gradually restore full active range of motion (AROM) of the elbow, forearm, and wrist; protect the healing tendon from excessive tension; minimize scar tissue formation.
• Precautions & Restrictions: No resistive wrist flexion or forearm pronation; avoid lifting objects heavier than 1 to 2 pounds (e.g., a coffee cup); avoid terminal passive stretching of the wrist flexors; do not push off from chairs or put direct pressure on the inner elbow.
• Suggested Exercises: Active-assisted and active elbow flexion and extension (in a pain-free range); active forearm pronation and supination (gentle, pain-free range); active wrist extension and wrist flexion (starting in gravity-eliminated positions); gentle, passive wrist flexor stretching (mild sensation, no sharp pain); light scar tissue mobilization once the incision is fully healed.
• Criteria to Progress: Near-full active range of motion of the elbow and wrist; minimal to no pain with basic, light activities of daily living (ADLs).

Phase III: Early Strengthening and Conditioning (Weeks 6 - 12)

At six weeks, the repair is strong enough to tolerate light resistance. Exercises will focus on rebuilding strength and endurance in the wrist flexors and pronators.

• Goals: Restore full passive and active range of motion of the elbow and wrist; initiate light, progressive strengthening of the wrist flexors, pronators, and surrounding musculature; improve scapular and rotator cuff strength to support upper extremity function.
• Precautions & Restrictions: Avoid sudden loading, heavy lifting, or repetitive gripping; limit lifting to 5 to 10 pounds (gradually progressed); discontinue any exercise that causes sharp pain or lingering ache at the medial epicondyle.
• Suggested Exercises: Submaximal isometric wrist flexion and forearm pronation; progressive concentric and eccentric wrist flexion/pronation using light dumbbells (starting at 1-2 lbs) or light resistance bands; wrist extension and supination strengthening; elbow flexion (biceps curls) and extension (triceps press) with light weights; shoulder, rotator cuff, and scapular stabilization exercises.
• Criteria to Progress: Full, pain-free active and passive range of motion of the elbow, wrist, and forearm; completion of light strengthening exercises without post-exercise pain or irritation.

Phase IV: Advanced Strengthening and Return to Activity (Weeks 12+)

This final phase prepares the patient for a safe return to work, sports (such as golf, tennis, or throwing), and heavy lifting activities through advanced conditioning.

• Goals: Restore normal strength, endurance, and power of the wrist flexor/pronator group (matching the uninjured side); gradually return to sport-specific and work-specific activities; establish a long-term home maintenance program to prevent recurrence.
• Precautions & Restrictions: Ensure a proper warm-up before all strenuous activities; gradually transition back to sport or heavy work (do not resume full play immediately); stop any activity if pain occurs at the medial epicondyle.
• Suggested Exercises: Progressive resistance training (gradually increasing weights for wrist flexion, extension, pronation, and supination); eccentric wrist flexor strengthening under higher loads; upper body plyometric exercises (e.g., medicine ball tosses); sport-specific progression (e.g., golf swing progression starting with putting, chipping, and moving to short irons; tennis groundstrokes starting at 50% effort); general upper extremity conditioning.
• Criteria to Progress / Discharge: Pain-free participation in daily work, home, and recreational activities; wrist flexor/pronator strength is at least 90% of the contralateral (uninjured) side.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.