Shoulder Instability Laterjet Rehab

 

• Minimize shoulder pain and inflammatory response
• Protect the integrity of the surgical repair: NO shoulder or elbow active range of motion (AROM) until week 3
• Gradually restore pain free passive range of motion (PROM)
• Enhance/ensure adequate scapular function

Sling:

• To be worn at all times except when bathing or performing therapy PROM:
• Glenohumeral (GH) flexion to 90 degrees
• Abduction in the plane of the scapula to 90 degrees
• Internal rotation (IR) to 45 degrees at 30 degrees of abduction
• External rotation (ER) to 25 degrees at 30-40 degrees of abduction; respect anterior capsule tissue integrity with ER ROM.

Therapeutic Exercises:

• Pendulum exercises
• Scapular stabilization exercises
• Ball squeezes
• Active assisted and active range of motion (AAROM/AROM: wrist, fingers, and supination/pronation with arm in

sling (at 90 degrees of elbow flexion)

• Passive elbow flexion/extension
• At week 3: Initiate Submaximal GH isometrics: flexion, extension, abduction, IR, ER

Modalities/Education:

• Frequent cryotherapy for pain and inflammation
• Pre-modulated electrical stimulation to shoulder for pain reduction
• Patient education regarding posture, joint protection, positioning, hygiene, etc.

Manual:

• Scar and soft tissue mobilization as needed
• GH, Sternoclavicular (SC), scapularthoracic (ST), and thoracic joint mobilizations: Grade I-II

Post-Operative Phase II (Week 4-6)

Goals:

• Minimize shoulder pain and inflammatory response
• Protect the integrity of the surgical repair
• Progress PROM
• Begin light waist level activities

Sling:

• Discontinue use of pillow as directed by physician/therapist after week 4.
• Begin to wean from sling between weeks 5-6.
• Discontinue sling as directed by physician/therapist after week 6

ROM:

• Progress shoulder PROM (do not force any painful motion)
• Forward flexion to 160 degrees
  Abduction in the plan of the scapula to 120 degrees o IR to 60 degrees at multiple angles of abduction
• ER to 35 degrees at 0-40 degrees of abduction then progress to multiple angles of abduction o Initiate extension to 40 degrees at 6 weeks

Therapeutic Exercises:

• Posterior capsular stretching as needed
• Progress to AAROM/AROM exercises of the shoulder with proper GH rhythm

Full active elevation in the scapular plane should be achieved before beginning active elevation in other planes

• Continue AROM of elbow, wrist, and hand
• Progress scapular stabilization exercises

Modalities:

• Continue cyrotherapy for pain and inflammation
• Pre-modulated electrical stimulation to shoulder for pain reduction

Manual:

• Scar and soft tissue mobilization as needed
• GH, AC, SC, thoracic and ST joint mobilizations : Grade I-IV as needed

Post-Operative Phase III (Week 7-9)

Goals:

• Achieve normal GH and scapular rhythm
• Achieve PROM WNL
• Progress to AROM WNL
• Remain pain free for all exercises

ROM/Therapeutic Exercises:

• Progress as tolerated, concentric and eccentric exercises
• Achieve full PROM/AROM in a given plane before strengthening in that plane
• Initiate:
  • Closed chain activities
  • Light pec stretch to tolerance
  • ER/IR strengthening
  • Side lying ER with towel roll
  • Manual resistance to ER in supine in scapular plane
  • ER/IR with exercise tubing at 0 degrees of abduction (towel roll)
  • Prone rowing at 30/45/90 degrees of abduction to neutral arm position

• Begin rhythmic stabilization drills

• ER/IR in the scapular plane
• Flexion/extension and adduction/abduction at various angles of elevation ·Progress AROM to isotonics: flexion, scaption, abduction

Manual:

• Scar and soft tissue mobilizations as needed
• GH, AC, SC, thoracic and ST joint mobilizations: Grades I-IV

Cardio:

• Stationary bike, elliptical with light upper body, stair climber Modalities:
• Continue cyotherapy for pain and inflammation
• Pre-modulated electrical stimulation to shoulder for pain reduction
• Continued patient education: posture, joint protection, positioning, hygiene, etc.

 

Post-Operative Phase IV (Week 10-15)

Goals:

• Normalize strength, endurance, neuromuscular control; All UE MMT grades 5/5
• Return to shoulder height functional activities
• Gradual and planned buildup of stress to anterior joint capsule

Precautions:

• Do not overstress the anterior capsule with aggressive overhead activities/strengthening
• Avoid contact sports/activities
• Patient education regarding a gradual increase to shoulder activities

Activity:

• Continue A/PROM as needed
• Initiate biceps, pectoralis major/minor, and serratus anterior strengthening
• Progress subscapularis strengthening to focus on both upper and lower segments:
  • IR resistive band at 45, 90 degrees of abduction
• Progress isotonic strengthening if patient demonstrates no compensatory strategies, is not painful, and has no residual soreness

Post-Operative Phase V (Week 15 – 24/Return to Sport)

Goals:

• Maintain full non-painful P/AROM
• Return to full strenuous work, throwing, and overhead activities

Precautions:

• Avoid excessive anterior capsule stress
• DO NOT PERFORM: tricep dips, wide grip bench press, military press or lat pulls behind the head.
• Do not flex elbows past 90 degrees in weight bearing positions
• Be sure to “always see your elbows”
• Do not begin plyometrics, throwing, or overhead athletic moves until 4 months post-op.

Therapeutic Exercise:

• Continue to advance scapula and upper extremity strengthening as tolerated in all planes o Include: diagonal/functional patterns, 90/90 strengthening, and CKC exercises

Cardio:

• Stationary bike, jogging/running/sprinting on treadmill, elliptical, rowing, kick board in swimming pool, stair climber

Milestones for return to sport activities and clearance:

• Completion and passing of shoulder functional test at MD PT clinic
• No complaints of pain or instability
• Adequate ROM for task completion bilaterally
• Full strength and endurance of rotator cuff and scapular musculature for task completion bilaterally
• Regular completion of home exercise program