Protective Phase (0-6 weeks post-operative):Goals:
- Minimize pain.
- Allow for soft tissue healing.
- Improved neuromuscular control and volitional activation of periscapular muscles.
- Limit PROM/AAROM flexion-90, ABD-90, IR-45, ER-45 in neutral.
- No shoulder AROM until 6 weeks, no RROM until 8 weeks.
- No lifting, sudden movements or supporting of body weight with hand.
- Wear sling as recommended by physician. Remove for rehab or bathing.
- Shoulder PROM/AAROM flexion, ABD, IR, ER (rotation 0-45 ABD)
- AROM/RROM hand, wrist, elbow
- Gentle IR behind back
- Isometric scapular retraction/depression
Intermediate Phase (6-8 weeks post-operative):Discontinue sling at 6 week follow up with Dr. LaFrance.
- Painless PROM/AAROM/AROM flexion-140, ABD-120, IR-70, ER-90 (rotation at 90 ABD) IR behind back to T10.
- Limit PROM/AAROM/AROM flexion 140, ABD 120.
- No shoulder RROM until 8 weeks.
- No lifting objects.
- RROM hand, wrist.
- Continue with persiscapular isometrics.
- Initiation of sub-maximal shoulder isometric IR/ER/ABD/Flex/Ext in GH neutral.
- Initiate shoulder AROM all planes starting in gravity lessened positions and progress against gravity as tolerated within restrictions.
Initial Strengthening Phase (8-12 weeks):Goals:
- Obtain Full PROM/AROM
- 4+/5 RC, scapular stabilizers
- No heavy lifting especially above shoulder level
- Full PROM/AAROM/AROM all planes
- RROM rotator cuff shoulder flexion, ABD, IR/ER, scaption.
- Endurance training (UBE).
- Scapular stabilization RROM and progress rhythmic stabilization.
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.
- RROM Rotator cuff and periscapular strengthening progressing to functional positions.
- Plyometrics progression.
- Sport specific, work specific training.