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.