Acute Protective Phase (0-2 weeks post operative):

Goals:
  • Pain under control with use of medication, ice, sling.
  • Maintain integrity of repair.
  • Supple PROM flexion-90, ABD-90, IR-45, ER-45 (rotation 0 at ABD).
Contraindications/Precautions:
  • No 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 only.
  • Keep incision clean and dry.
Rehab to Include:
  • Shoulder PROM in clinic and at home for flexion, ABD, IR, ER (rotation 0-45 ABD).
  • Joint mobilization grade I-II glenohumeral and scapulothroracic.
  • Pendulum exercise.
  • AROM hand/wrist/elbow.
  • Isometric scapular retraction and depression.
  • Pain modalities.

Subacute Phase (2-8 weeks post-operative):

Goals:
  • Minimize pain .
  • Allow for soft tissue healing.
  • Supple PROM flexion-120, ABD-120, IR-50, ER-70 (rotation 0-45 ABD).
Contraindications/Precautions:
  • No shoulder AROM.
  • No lifting, sudden movements, or supporting body weight on hand.
  • Wear sling as recommended by physician. Remove for rehab only.
Rehab to include:
  • Shoulder PROM flexion, ABD, IR, ER, (rotation 0-45 ABD).
  • Joint mobilization grade I-III glenohumeral and scapulothroacic.
  • AROM/PROM hand, wrist, elbow.
  • AAROM shoulder flexion, ABD, IR, ER to tolerance (rotation 0-45 ABD).
  • Flexibility Apley IR.
  • Submaximal isometric scapular retraction/depression.

Intermediate Phase (8-10 weeks post-operative):

Discontinue use of sling at 8 weeks post op.

Goals:
  • Painless full supple PROM flexion-180, ABD-180, IR-90, ER-90 (rotation at 90 ABD).
  • Full AROM.
Rehab to include:
  • Continue AAROM, flexibility PRN.
  • Jt. Mobs Gr I-IV G-H.
  • AROM shoulder flexion, ABD, IR, ER to tolerance beginning in gravity lessened positions then progressing against gravity as tolerated.
  • RROM hand, wrist, elbow.
  • Isometric scapular retractions/depressions.
  • Initiation of sub-maximal shoulder isometric IR/ER/ABD/Flex/Ext in GH neutral.
Contraindications/Precautions:
  • No RROM RC.
  • No lifting objects.

Strengthening Phase (10-15 weeks ):

Goals:
  • Maintain full AROM.
  • 4+/5 RC scapular stabilizers.
Contraindications/Precautions:
  • No heavy lifting especially above shoulder level.
Rehab to include:
  • RROM rotator cuff shoulder flexion, ABD, IR/ER.
  • Endurance training (UBE).
  • Scapular stabilization RROM.

Advanced Functional Strength Phase (16 weeks-on):

Goals:
  • 5/5 RC scapular stabilizer strength.
  • Independent long term HEP.
  • Return to normal function and sports activities.
Rehab to include:
  • Aggressive RROM rotator cuff progressing to functional positions.
  • Plyometrics.
  • Sports specific, work specific training

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