Acute Protective Phase (0-2 weeks post-operative):
Goals:- Pain under control with use of medication, ice, and sling.
- Maintain integrity of repair.
- Supple PROM as tolerated to attain flexion-90, ABD-90, IR-40, ER-45 (rotation at 0 ABD).
- Avoid shoulder AROM or aggressive stretching.
- No lifting, sudden movements, or supporting of body weight with hand.
- Wear sling as recommended by physician. Remove for rehab or bathing.
- Keep incision clean/dry until physician follow-up and suture removal.
- Shoulder PROM in clinic and at home for flexion, ABD, IR, ER (rotation 0-45 ABD).
- Joint mobilization grade I-II glenohumeral and scapulothoracic .
- Pendulum exercise.
- AROM hand/wrist/elbow.
- RROM hand/wrist.
- Submaximal isometrics for scapular retraction/depression.
- Pain modalities.
Subacute Phase (2-4 weeks post-operative):
Goals:- Minimize pain.
- Allow for soft tissue healing.
- Supple PROM as tolerated to attain flexion-120, ABD-120, IR-50, ER-70 (rotation at 45 ABD).
- Improved neuromuscular control and volitional activation of periscapular muscles.
- No shoulder AROM until 4 weeks, no RTC RROM until 6 weeks.
- No lifting, sudden movements or supporting of body weight with hand.
- Continue use of sling.
- Shoulder PROM flexion, ABD, IR, ER (rotation 0-45 ABD).
- Joint mobilization grade I-III glenohumeral and scapulothoracic .
- AROM/RROM hand, wrist, elbow.
- AAROM/PROM shoulder flexion, ABD, IR, ER, to tolerance (rotation 0-45 ABD).
- Flexibility apley IR.
- Submaximal isometrics for scapular retraction/depression
Intermediate Phase (4-6 weeks post-operative)
Goals:- Painless full supple PROM flexion-180, ABD-180, IR-90, ER-90 (rotation at 90 ABD).
- Painless full AROM flexion-180, ABD-180, IR-70, ER-90 (rotation at 90 ABD) apley IR T10.
- No shoulder RROM until 6 weeks.
- No lifting objects.
- Continue PROM/AAROM.
- Initiate Shoulder AROM starting in gravity lessened positions progressing to against gravity as tolerated.
- Initiate sub-maximal shoulder isometrics in GH neutral for flexion, ABD, EXT, IR, ER.
- RROM hand, wrist, elbow.
Strengthening Phase (6-12 weeks):
Goals:- Maintain full AROM.
- 4+/5 RC, scap stabilizers.
- No RROM IR/ER rotation at 90 degrees unless supine/prone.
- No heavy lifting, especially above shoulder level.
- RROM rotator cuff shoulder flexion, ABD, IR/ER, scaption.
- RROM scapular stabilization.
- Progress to functional position, strengthen rotator cuff at 90 degrees ABD supine/prone.
- Endurance training (UBE).
- Continue scapular retraction .
- Initiation of rhythmic stabilization training for IR/ER and FF/EXT.
Advanced Functional Strength Phase (12 weeks-on):
Goals:- Strengthen and further stabilize RC and scap stabilizers.
- Independent long-term HEP.
- Return to normal function and sports activities.
- Aggressive RROM Rotator cuff and periscapular structures in functional positions.
- Plyometrics with volume progression.
- Sport specific, work specific training.