Zero to Six weeks Post-op: Acute Phase

Precautions:
  • Avoid resisted range of motion internal rotation for 8 weeks.
  • Avoid active range of motion for 6 weeks.
  • No external rotation greater than 45 degrees for 4 weeks.
  • No abduction greater than 90 degrees for 4 weeks.
  • Continue use of sling until physician states otherwise.
Therapeutic Exercises:
  • Elbow and forearm active range of motion, progress to resistive range of motion to tolerance.
  • Active assisted forward flexion to tolerance, scaption and abduction less than 90 degrees.
  • Pendulum exercises.
  • Passive and active assisted external rotation to 45 degrees at 0 degrees abduction.
  • Passive internal rotation behind the back to tolerance.
  • Isometric scapular retractions, depression.
  • Submaximal isometric abduction, external rotation, extension.
  • Passive range of motion flexion to tolerance, abduction not past 90 degrees, external rotation at 0 degrees abduction not past 45 degrees, internal rotation at 45 degrees abduction to tolerance.

Six Weeks Post-op: 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 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 to standing as tolerated.
  • Isotonic tubing scapular retraction.
  • PROM to tolerance flexion, abduction, external rotation at 0 degrees abduction and internal rotation at 45 and 90 degrees abduction.

Eight to Nine 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 closed chain stabilization exercise in standing (i.e. wall pushups).
  • UBE

Ten to 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).

Twelve Weeks Post-op: Functional progression

  • Continue strengthening as above.
  • Begin plyoball training.
  • Begin throwing progression.
  • Simulate sport specific motion for over-head athletes.

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