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

Goals:
  • Pain under control with use of medication, ice, and sling.
  • Maintain integrity of repair.
  • Supple PROM as tolerated to attain flexion-90, ABD-90, IR-40, ER-45 (rotation at 0 ABD).
  • Initiate sub-maximal isometrics for scapular retraction/depression.
Contraindications/Precautions:
  • Avoid 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 or bathing.
  • Keep incision clean/dry until physician follow-up and suture removal.
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 scapulothoracic .
  • Pendulum exercise.
  • AROM hand/wrist/elbow.
  • RROM hand/wrist.
  • Submaximal isometrics for scapular retraction/depression.
  • Pain modalities.

Subacute Phase (2-6 weeks post-operative):

Goals:
  • Minimize pain.
  • Allow for soft tissue healing.
  • Supple PROM as tolerated to attain flexion-120, ABD-120, IR-50, ER-70 (rotation at 45 ABD).
  • Improved neuromuscular control and volitional activation of periscapular muscles.
Contraindications/Precautions:
  • No shoulder AROM until 6 weeks, no RTC RROM until 8 weeks.
  • No lifting, sudden movements or supporting of body weight with hand.
  • Wear sling as recommended by physician. Remove for rehab or bathing.
Rehab to include:
  • Shoulder PROM flexion, ABD, IR, ER (rotation 0-45 ABD).
  • Joint mobilization grade I-III glenohumeral and scapulothoracic .
  • AROM/RROM hand, wrist, elbow.
  • AAROM shoulder flexion, ABD, IR, ER, to tolerance (rotation 0-45 ABD).
  • Flexibility apley IR.
  • Isometric scapular retraction/depression.

Intermediate Phase (6-8 weeks post-operative)

Discontinue sling at 6 week follow up with Dr. LaFrance.

Goals:
  • Painless full supple PROM flexion-180, ABD-180, IR-90, ER-90 (rotation at 90 ABD).
  • Painless full AAROM/AROM flexion-180, ABD-180, IR-70, ER-90 (rotation at 90 ABD) apley IR T10.
Contraindications/precautions:
  • No shoulder RROM until 8 weeks.
  • No lifting objects.
Rehab to include:
  • RROM hand, wrist.
  • Continue with persiscapular isometrics.
  • Initiation of sub-maximal shoulder isometric IR/ER/ABD/Flex/Ext in GH neutral.
  • Initiate shoulder AROM in all planes, starting in gravity lessened positions and progressing against gravity as tolerated without pain.

Initial Strengthening Phase (8-12 weeks):

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

Advanced Functional Strength Phase (12 weeks-on):

Goals:
  • Strengthen and further stabilize RC and scap stabilizers.
  • Independent long-term HEP.
  • Return to normal function and sports activities.
Rehab to include:
  • Aggressive RROM Rotator cuff and periscapular strengthening progressing to functional positions.
  • Plyometrics progression.
  • Sport specific, work specific training.

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