Initial Protective Phase (0-4 weeks post-operative):

Precautions:
  • Continue use of sling per physician orders.
  • No active elbow flexion until 4 weeks post op.
  • No active wrist supination until 4 weeks post op.

Therapeutic Exercise (weeks 1-4):

  • Full PROM and AAROM of the shoulder in all planes as tolerated.
  • Initiate shoulder AROM to tolerance in all planes of motion beginning in gravity lessened positions and progressing against gravity as tolerated.
  • Light sub maximal isometric shoulder abduction, external rotation, internal rotation, extension, and scapular retraction.
  • Initiate passive and light active assisted elbow flexion, extension and wrist supination.
  • Initiate wrist flexibility flexion, extension, supination, and pronation as needed.

Intermediate Phase (weeks 4-5):

  • Discontinue use of sling.
  • Begin active elbow flexion and extension.
  • Begin active wrist supination.
  • Progress shoulder PROM, AAROM, and AROM to achieve full ROM.
  • Continue wrist flexibility to ensure full wrist ROM is available.

Strength Phase (weeks 6-9):

  • Initiate progressive resisted elbow flexion.
  • Initiate progressive resisted wrist supination.
  • Initiate progressive resisted shoulder external rotation, internal rotation, adduction, scapular retraction, abduction, and shoulder flexion as tolerated.
  • 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)

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.

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