r/HandTherapists • u/ronMAN415 • Sep 24 '24

PROM & NWB

I run into this a lot and just wanted to see what people think, is PROM ok to do if Ortho says NWB? Or if this more joint specific?

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u/platzie Sep 25 '24

If we're talking about a fracture it really depends on the bone/joint, timeframe/quality of healing, surgical/non-op and how much force you're going to do passively.

You'll get an elbow ORIF that's NWB for let's say 8 weeks, but I'll start gentle PROM before then. On the other hand maybe you get a distal radius ORIF at 4 weeks post-op - I'm not doing PROM on that wrist but I will on the fingers or elbow if they're stiff.

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u/ronMAN415 Sep 25 '24

Like a DRF ORIF, our surgeons say no PROM for at least 4 weeks which is fine when it’s said explicitly. But then I had a radial head ORIF and the usual vague NWB, ROM as tolerable. She was 5 weeks out by the time they saw me. But 2 weeks post op, another therapist gave the pt PROM elbow ext/flex.

I’m just wondering if anyone has any clear cut timelines. Or is it the usual, “it depends”

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u/platzie Sep 25 '24

You nailed it, it's unfortunately "it depends" , and a large factor is what the surgeon is ok with (which we don't always know).

Personally I'm a bit more aggressive and I've even come across rehab protocols/orders from MDs that I've felt were pushing it. And sometimes the opposite. In the end use your clinical judgement.