Post-Operative Rehabilitation
ANTERIOR STABILIZATION
0-4 Weeks: MAXIMAL PROTECTION PHASE
Sling Immobilization
Protect anterior/posterior capsule from stretch, but begin passive ROM only POD 10-14
Supine Forward Elevation in scapular plane to 90°
External Rotation with arm at side to 30°.
Grip Strength, Elbow/Wrist/Hand ROM
Do NOT perform codmans
Begin Deltoid/Cuff Isometrics
May remove sling for shower but maintain arm in sling position.
4-8 Weeks: MODERATE PROTECTION PHASE
Discontinue Sling at 4-6 weeks as tolerated
Advance to AAROM and AROM (Limit FF to 140°, ER at side to 40°)
Begin with gravity eliminated motion (supine) and progress. Do not force ROM with substitution patterns.
Continue Isometric exercises
Progress deltoid isometrics
ER/IR (submaximal) with arm at side
Begin strengthening scapular stabilizers
8-12 Weeks: MINIMAL PROTECTION PHASE
Advance to full, painless ROM. Gentle stretching at end ROM
Initiate ER in 45º Abduction at 10-12 weeks
Full AROM all directions below horizontal with light resistance
Deltoid/Cuff progress to Isotonics
All strengthening exercises below horizontal
3-12 Months: STRENGTHENING PHASE
Initiate when pain-free symmetric AROM.
Progress as tolerated
Only do strengthening 3x/week to avoid rotator cuff tendonitis
Restore scapulohumeral rhythm.
Joint mobilization.
Aggressive scapular stabilization and eccentric strengthening program.
Initiate isotonic shoulder strengthening excercises including: side lying ER,
prone arm raises at 0, 90, 120 degrees, elevation in the plane of the scapula with IR and ER, lat pulldown close grip, and prone ER.
Dynamic stabilization WB and NWB.
Long Term return to sport plan
1) Begin isokinetics.
2) Begin muscle endurance activities (UBE).
High seat and low resistance
Must be able to do active shoulder flexion to 90 degrees without substitution
3) Continue with agility exercises.
4) Advanced functional exercises.
5) Isokinetic test.
6) Functional test assessment.
7) Full return to sporting activities.