Initial Protective Phase (0-4 weeks post-operative)Precautions:
- No active shoulder elevation until 4 weeks post-op. (if there was no superior labral repair active shoulder elevation is allowed.)
- Continue use of sling unless the arm is supported while sitting.
- No internal rotation behind the back until 4 weeks post op.
- No shoulder horizontal adduction until 4 weeks post op.
- No passive elevation beyond 90 degrees until 4 weeks post op.
- No external rotation beyond 45 degrees at 0 degrees abduction until 4 weeks post op.
Therapeutic Exercise (weeks 1-4)
- Full AROM elbow, wrist and hand.
- Codman pendulum exercise.
- External rotation PROM, AAROM, and AROM limited to 45 degrees at 0 degrees abduction.
- Flexion and abduction AAROM and PROM limited to 90 degrees.
- Light sub maximal isometric abduction, external rotation, internal rotation, extension, and scapular retraction.
Intermediate Phase (weeks 4-5)
- Discontinue use of sling.
- Progress flexion and abduction PROM and AAROM as tolerated beyond 90 degrees elevation.
- Initiate flexion and abduction AROM to tolerance.
- Progress external rotation ROM as tolerated beyond 45 degrees at 0 and 45 degrees abduction.
- Initiate internal rotation flexibility and AAROM behind the back to tolerance.
- Initiate AROM to tolerance in all planes of motion beginning in gravity lessened positions and progressing against gravity as tolerated.
- Progress sub maximal isometric flexion, abduction, external rotation, extension and scapular retraction.
- Progress PROM in all planes as tolerated.
Strength Phase (weeks 6-9)
- Continue progressive PROM and AAROM in all planes to achieve full shoulder ROM.
- Initiate external rotation and internal rotation ROM as tolerated at 90 degrees of abduction.
- Continue AROM exercises.
- Initiate progressive resisted exercise shoulder flexion, abduction, external and internal rotation, horizontal abduction and adduction. Do not go beyond neutral horizontal adduction.
- Initiate rhythmic stabilization internal and external rotation at 0 degrees, 45 degrees, and 90 degrees abduction. Initiate flexion and extension rhythmic stabilization at 90 degrees flexion and horizontal abduction and adduction rhythmic stabilization at 90 degrees flexion.
- Start closed chain stabilization exercise in standing (i.e. wall pushups).
- Begin horizontal adduction flexibility if needed at 8 weeks post-operative.
Advance Strength and Stabilization (weeks 10-11)
- Continue progressive resisted exercise as above.
- Initiate rotator cuff strengthening at 90 degrees of abduction.
- Progress closed chain stabilization exercise against body weight (i.e. table pushups progressing to floor, swiss ball stabilization).
Advanced Plyometric and Throwing Phase (week 12)
- Continue strengthening as above.
- Begin plyoball training.
- Begin throwing progression.
- Simulate sport specific motion for over-head athletes.