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Physical Rehabilitation Medicine/medial epicondyle avulsion fx w ORIF


My son is an outfielder for a travelling baseball team and underwent an ORIF of his medial epicondyle after an avulsion injry playing dodge ball.  I can't find much on the rehab for this type of injury.  I'm a PT and am trying to find out what will dictate his return to batting/playing in the outfield.  Cast comes off tomorrow and I found a rehab for thrower's elbow by Kevin Wilk, PT that I plan to try to utilize as a guideline, but, really, there is just not anything out there for healing time and safe throwing time.  The ORIF was a single screw.  Surgeon stated there was not much soft tissue damage.  Just looking for any insight you might have/experience with growth plate injuries and return to playing status.  Any ideas where to look for more info or whose brain to pick is greatly appreciated as well.  Thanks.   Also, my hip...naw just kidding!  Love your disclaimer about lower extemity stuff!

HA!  Glad you liked that.  I get people all the time asking "hey I had a hernia and...."  I'm like umm did ya not read my profile?!

Ok, I would take things VERY slowly.  That bone will be healed in about 6 weeks if he's between 16-25.  Especially if it's screw fixation.  Go with a progressive strengthening program that incorporates isometric followed by isotonic strengthening of the flexor carpi ulnaris.  This muscle puts a tremendous amount of stress to the medial epicondyle.  Also if it's intra-articular you want to be careful.  At the same time you're doing the FCU strengthening do some scapular strengthening to take the stress off of the bone.  I would work a lot on that.

Then progress to throwing by using graded weight from just making the motion to using a tennis ball, then a baseball etc.  It all depends on pain.  If he has pain, he's going too fast and slow down.

I'm not a throwing expert.  But as you know, therapy is simply graded stress to the tolerance of tissue/bone.  If you find something similar to the above I'd go with it.

Good luck!

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Brian Neville, OTR/L, CWCE


I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!


10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

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Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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