Olecranon Bursectomy Protocol

An olecranon bursectomy is a surgical procedure to remove the inflamed or infected olecranon bursa at the tip of the elbow. Because the skin over the posterior elbow is thin and has a limited blood supply, wound healing is the primary concern in the early post-operative period. This rehabilitation protocol focuses on protecting the surgical incision while gradually restoring range of motion, muscle strength, and functional elbow use.

Phase I: Protection & Early Motion (Weeks 0 - 2)

Goals:

• Protect the surgical site and incision to ensure optimal healing.
• Control pain, swelling, and inflammation.
• Initiate gentle range of motion within safe limits.
• Maintain mobility of the wrist, hand, and shoulder.

Precautions & Restrictions:

• Strictly avoid direct pressure or friction on the back of the elbow (no resting the elbow on armrests or tables).
• Keep the post-operative dressing/splint intact and dry until the first follow-up appointment (sutures are typically removed at 10 to 14 days).
• Avoid active elbow extension against resistance to protect the posterior soft tissue.
• Do not lift objects heavier than a cup of water with the surgical arm.

Suggested Exercises:

• Gentle active and active-assisted range of motion (A/AAROM) for elbow flexion and extension (limit flexion to 90 degrees or comfort initially, progressing as tolerated).
• Active range of motion (AROM) for the fingers, hand, wrist (flexion/extension, pronation/supination), and shoulder in all planes.
• Grip strengthening using a soft ball or putty.
• Frequent elevation of the hand and wrist above heart level to manage distal swelling.

Criteria to Progress:

• Incision is fully closed and sutures or staples have been removed.
• Swelling is stable or resolving, and pain is well-controlled.
• Elbow active flexion reaches at least 90 degrees and extension is near full.

Phase II: Range of Motion & Light Strengthening (Weeks 2 - 6)

Goals:

• Restore full active and passive range of motion of the elbow and forearm.
• Introduce light resistive exercises and daily functional tasks.
• Promote healthy scar tissue maturation.

Precautions & Restrictions:

• Continue to protect the posterior elbow from direct pressure or impact.
• Limit lifting to less than 5 to 10 pounds.
• Avoid sudden, jerky movements or heavy pushing/pulling.

Suggested Exercises:

• Active and passive range of motion to achieve full elbow flexion, extension, pronation, and supination.
• Gentle scar tissue massage directly over and around the healed incision.
• Light isometric exercises for elbow flexion and extension (submaximal, pain-free).
• Progressive strengthening using light resistance bands or 1-2 lb dumbbells for wrist flexion/extension, pronation/supination, and biceps curls.
• Begin light, non-resistive active elbow extension (triceps active range of motion) against gravity.

Criteria to Progress:

• Full, pain-free active range of motion in elbow flexion, extension, pronation, and supination.
• Complete wound healing with no signs of drainage or inflammation.
• Good tolerance to light isometrics and active movement.

Phase III: Advanced Strengthening & Functional Return (Weeks 6 - 12+)

Goals:

• Restore full strength, power, and muscular endurance.
• Gradually return to recreational activities, work, and sports.
• Ensure long-term protection of the posterior elbow skin.

Precautions & Restrictions:

• Avoid direct impact or trauma to the posterior elbow (e.g., in contact sports). Consider protective elbow padding if returning to impact activities.
• Listen to body signals; stop any activity that causes sharp pain or recurring swelling.

Suggested Exercises:

• Progressive resistive exercises (PREs) for elbow flexion and extension using bands or free weights.
• Forearm strengthening (pronation/supination and wrist curls) with progressive resistance.
• Closed-chain exercises (e.g., wall push-ups, progressing to regular push-ups as tolerated).
• Rotator cuff and scapular stabilization exercises to support the entire upper extremity kinetic chain.
• Sports-specific or job-specific drills and movement training.

Criteria to Progress:

• Full, pain-free range of motion.
• Elbow flexion and extension strength matches the uninvolved arm (or is at least 90%).
• Safe and pain-free execution of sports-specific or work-related tasks.

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.