Posterior Capsular Shift and Posterior Labral Repair Protocol

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

• Avoid active shoulder elevation.
• Continue use of sling unless the arm is supported while sitting.
• No internal rotation behind the back until 4 weeks post op.
• No shoulder horizontal adduction until 4 weeks post op.
• No elevation beyond 90 degrees until 4 weeks post op.

• Full AROM elbow, wrist and hand.
• Codman pendulum exercise.
• External rotation PROM, AAROM and AROM to tolerance at 0 and 45 degrees of abduction.
• Flexion and abduction AAROM and PROM limited to 90 degrees.
• Light sub maximal isometric abduction, external rotation, internal rotation, and extension.

Intermediate Phase (weeks 4-5)

• Discontinue use of sling.
• Progress flexion and abduction PROM, AAROM, and AROM to tolerance beyond 90 degrees elevation.
• Begin internal rotation flexibility and AAROM behind the back to tolerance.
• Start AROM to tolerance in all planes of motion beginning in gravity lessened positions and progressing against gravity as tolerated.
• Continue sub maximal isometric flexion, abduction, external rotation and extension.
• Progress PROM in all planes to full.

Strength Phase (weeks 6-9):

• Continue progressive PROM and AAROM all planes to achieve full shoulder ROM.
• Continue AROM exercises.
• Start progressive resisted exercise shoulder flexion, abduction, external and internal rotation, horizontal abduction and adduction. Do not go beyond neutral horizontal adduction.
• Start rhythmic stabilization exercise: internal and external rotation at 0 degrees, 45 degrees, and 90 degrees abduction and flexion and extension at 90 degrees flexion, horizontal abduction and adduction at 90 degrees flexion.
• Start closed chain stabilization exercise in standing (i.e. wall pushups).
• Begin horizontal adduction flexibility if needed at 8 weeks post operatively.

Advance Strength and Stabilization (weeks 10-11):

• Continue progressive resisted exercise as above.
• Start 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).

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.