Background: Advanced elbow arthritis following post-traumatic conditions such as non-union of the ulna can result in pain, instability, and significant functional impairment. In severe cases, the elbow may become flail and non-functional, particularly affecting individuals involved in manual labor. Total elbow arthroplasty (TEA) is a well-established surgical option to restore joint stability, reduce pain, and improve functional outcomes. However, optimal recovery largely depends on a structured physiotherapy rehabilitation program.

Aim: To evaluate the functional outcome of total elbow arthroplasty combined with physiotherapy rehabilitation in a patient with advanced elbow arthritis and a flail elbow.

Case Presentation: A 46-year-old female housemaid presented with complaints of left-hand pain and swelling in the left elbow, limiting her ability to perform occupational and daily activities. She had a history of non-union of the left ulna operated in 2016, which progressed to advanced elbow arthritis and joint instability. She underwent left total elbow arthroplasty. She was also a known case of hypertension and hypothyroidism. On physiotherapy assessment, pain was graded 5/10 at rest and 8/10 during movement. Range of motion was restricted with flexion 60°, extension lag of -20°, supination 60°, and pronation 60°. Manual Muscle Testing revealed reduced strength in elbow and forearm musculature (3/5), with wrist strength at 4/5. Functional activities such as lifting and gripping were impaired.

Intervention: A structured physiotherapy program was initiated, including pain management using cryotherapy, gentle activeassisted range of motion exercises, and gradual progression to active and resisted strengthening exercises. Isometric exercises were introduced in the early phase, followed by functional training focusing on activities of daily living and occupational tasks.

Outcomes: After rehabilitation, the patient showed considerable improvement in DASH score, Oxford elbow score, Mayo Elbow Performance Score, Michigan Hand Outcomes Questionnaire, Grip strength test, Box and block test and SF 36 in pain reduction, range of motion of the elbow (flexion, extension, pronation, and supination), and muscle strength. Grip strength and joint stability also improved, along with better proprioception and functional performance in activities of daily living. Overall, there was a marked reduction in post-operative stiffness, leading to enhanced functional independence and improved quality of life.

Results: The patient demonstrated significant improvement on all outcome measures with reductions in pain and improved levels of mobility and independence when engaged in daily activities.