上級 肘 捻挫・挫傷 リハビリテーション

Pain at lateral epicondyle and medial epicondyle reproduced by resisted wrist extension/flexion,Limited elbow flexion/extension due to joint capsule strain,Ulnar nerve hypersensitivity with elbow flexion tenderness,Swelling around radiohumeral joint < 2cm circumference difference,Able to tolerate light activities of daily living with modified technique,Pain-free grip strength > 50% contralateral side

→ 次の段階へ： Week 2-3: Subacute/Mobility

Pain localized to common extensor origin at lateral epicondyle < 3/10 at rest,Pain localized to common flexor origin at medial epicondyle < 3/10 at rest,Full elbow flexion (145°) and extension (0°) achieved,Ulnar nerve Tinel's sign negative or mildly positive only with direct pressure,Pronation and supination within 10° of contralateral side,No increase in swelling at humero-ulnar joint

→ 次の段階へ： Week 4-5: Early Strengthening

Full pain-free range of motion in all planes including forearm rotation,Ulnar nerve symptoms absent with elbow flexed at 90°,No tenderness on palpation of annular ligament or radial head,Can perform light functional tasks without compensations,Grip strength > 70% contralateral side measured by dynamometer,Tolerance to 15 minutes of continuous activity

→ 次の段階へ： Week 4-5: Early Strengthening

Resisted wrist extension at lateral epicondyle produces < 2/10 pain,Resisted wrist flexion at medial epicondyle produces < 2/10 pain,Can hold 2kg weight for 30 seconds in elbow flexion,Full pain-free supination and pronation against resistance,No ulnar nerve dysesthesia with sustained elbow flexion > 30 seconds,Cartilage tolerance demonstrated with low-impact loading activities

→ 次の段階へ： Week 6-7: Intermediate Strengthening

Pain-free resisted elbow flexion against gravity,Pain-free resisted elbow extension against gravity,Tolerance to repetitive gripping tasks (10 repetitions),No recurrence of swelling after strengthening exercises,Can perform work-related tasks requiring sustained elbow position,Patient-Rated Tennis Elbow Evaluation score < 40/100

→ 次の段階へ： Week 6-7: Intermediate Strengthening

Resisted forearm supination with elbow at 90° flexion produces no pain,Resisted forearm pronation with elbow at 90° flexion produces no pain,Can tolerate progressive resistance training up to 5kg for wrist,Eccentric loading of wrist extensors at lateral epicondyle tolerated,Eccentric loading of wrist flexors at medial epicondyle tolerated,No ulnar nerve provocation with repetitive elbow flexion/extension

→ 次の段階へ： Week 8-10: Advanced Strengthening

Grip strength 85% of contralateral side,Pain-free functional activities lasting > 30 minutes,No night pain or rest pain at elbow,Can perform lifting tasks up to 50% body weight,Nirschl pain scale score 0-2/7 during daily activities,DASH score < 20/100

→ 次の段階へ： Week 8-10: Advanced Strengthening

Full resistance testing of all wrist and elbow movements (5/5 MMT),Tolerance to high-repetition occupational tasks (100+ repetitions),No symptoms with valgus stress at medial elbow,No symptoms with varus stress at lateral elbow,Can perform throwing activities at 50% velocity,Ulnar nerve conduction studies normal if previously abnormal

→ 次の段階へ： Week 11-13: Sport/Functional Specific

Pain-free return to heavy lifting activities,Tolerance to eccentric overload at common extensor and flexor origins,Full strength symmetry (>90%) on isokinetic testing,No recurrence of cartilage symptoms with loading,Can complete 3 sets of 15 repetitions at moderate resistance,Mayo Elbow Performance Score > 90/100

→ 次の段階へ： Week 11-13: Sport/Functional Specific

Asymptomatic with all provocative tests negative,Complete work simulation without restrictions,Patient reported outcome measures at pre-injury levels,No compensatory movement patterns during lifting,Can tolerate backhand tennis stroke technique,Symptom-free for 2 consecutive weeks of training

→ 次の段階へ： Week 11-13: Sport/Functional Specific

Return to throwing at 75% velocity without pain,Can perform golf swing with full follow-through,Tolerance to repetitive impact loading at elbow,No ulnar nerve subluxation with athletic movements,Pain-free competitive play in controlled situations,Full endurance capacity in sport-specific tasks

→ 次の段階へ： Week 14-15: Return to Activity

Return to full athletic competition at 90% intensity,No exacerbation of symptoms post-activity,Complete 4 consecutive weeks without regression,Full confidence in elbow stability during dynamic movements,Proprioception testing within 10% of contralateral side,PRTEE score < 10/100

→ 次の段階へ： Week 14-15: Return to Activity

Return to unrestricted athletic participation,No ongoing modifications to technique required,Cartilage loading tolerance in high-impact sports,No recurrence of ulnar nerve symptoms under competition stress,Functional testing equivalent to pre-injury baseline,DASH sports module score < 5/100

→ 次の段階へ： Week 14-15: Return to Activity

Completed graduated return-to-sport protocol over 2 weeks,All performance metrics at pre-injury levels,No maintenance therapy required beyond home exercise,Full confidence in elbow under competitive stress,Patient satisfaction > 8/10 with outcome,No activity limitations reported

→ 次の段階へ： Week 15: Discharge/Maintenance

Asymptomatic at rest and with all activities,Full return to work without restrictions,Independent with maintenance strengthening program,Understanding of injury prevention strategies,Discharge criteria met for all outcome measures,No follow-up required unless symptoms return

→ 次の段階へ： Complete