Zero to Six weeks Post-op: Initial PhasePrecautions:
- Avoid resisted internal rotation for 8 weeks.
- Avoid external rotation greater than 30 degrees for 6 weeks.
- No flexion or abduction greater than 90 degrees for 6 weeks.
- Continue use of sling until 6 weeks post op.
- Elbow and forearm active range of motion, progress to resistive range of motion to tolerance.
- Active assisted forward flexion, scaption and abduction less than 90 degrees.
- Pendulum exercises.
- Passive and active assisted external rotation not past 30 degrees at 0 degrees abduction.
- Gentle passive internal rotation behind the back to tolerance.
- Isometric scapular retractions, depression.
- Passive range of motion flexion and abduction not past 90 degrees, external rotation at 0 degrees abduction not past 30 degrees, internal rotation at 45 degrees abduction to tolerance.
Six Weeks Post-op: Active Range of Motion Stage
- Active assisted range of motion forward flexion, scaption, and abduction to tolerance achieving full range of motion.
- Passive and active assisted external rotation to tolerance at 0 and 45 degrees abduction.
- Continue passive internal rotation behind the back to tolerance.
- Active range of motion, forward flexion, scaption, external rotation, extension, horizontal abduction, rows, and internal rotation. Start gravity lessened, progress against gravity as tolerated.
- Submaximal isometric abduction, external and internal rotation, and extension.
- PROM to tolerance flexion, abduction, external rotation at 0 and 45 degrees abduction and internal rotation at 45 and 90 degrees abduction.
Eight Weeks Post-op: Strengthening Phase
- Continue progressive PROM and AAROM to achieve full shoulder ROM.
- Advance external rotation range of motion as tolerated at 90 degrees abduction.
- Initiate progressive resisted exercise shoulder flexion, abduction, external and internal rotation, horizontal abduction, horizontal adduction, extension, adduction, and retraction.
- 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 light closed chain stabilization exercise in standing (i.e. wall pushups).
Twelve Weeks Post-op: Advanced Strengthening and Stabilization
- Continue progressive resisted exercise as above.
- Initiate rotator cuff strengthening at 90 degrees abduction.
- Progress closed chain stabilization exercise against body weight (i.e. table pushups progressing to floor, swiss ball stabilization).
Sixteen Weeks Post-op: Functional progression
- Continue strengthening as above
- Begin plyoball training.
- Begin throwing progression.
- Simulate sport specific motion for over-head athletes.