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

Goals:
  • Pain under control with use of medication, ice, sling.
  • Maintain integrity of repair.
  • Supple PROM flexion-90, ABD-90, IR-45, ER-45 (rotation 0 at ABD).
Contraindications/Precautions:
  • No 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 only.
  • Keep incision clean and dry.
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 scapulothroracic.
  • Pendulum exercise.
  • AROM hand/wrist/elbow.
  • Isometric scapular retraction and depression.
  • Pain modalities.

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

Goals:
  • Minimize pain .
  • Allow for soft tissue healing.
  • Supple PROM flexion-120, ABD-120, IR-50, ER-70 (rotation 0-45 ABD).
Contraindications/Precautions:
  • No shoulder AROM.
  • No lifting, sudden movements, or supporting body weight on hand.
  • Continue use of sling.
Rehab to include:
  • Shoulder PROM flexion, ABD, IR, ER, (rotation 0-45 ABD).
  • Joint mobilization grade I-III glenohumeral and scapulothroacic.
  • AROM/PROM hand, wrist, elbow.
  • AAROM shoulder flexion, ABD, IR, ER to tolerance of patient (rotation 0-45 ABD).
  • Flexibility Apley IR.

Intermediate Phase (6-8 weeks post-operative):

Goals:
  • Painless full supple PROM flexion-180, ABD-180, IR-90, ER-90 (rotation at 90 ABD).
  • Painless full AROM flexion-180, ABD-180, IT-70, ER-90 (rotation at 90 ABD) Apley IR T10.
Rehab to include:
  • Continue PROM/AAROM, flexibility PRN.
  • Jt. Mobs Gr I-IV G-H.
  • AROM shoulder flexion, ABD, IR, ER to tolerance beginning in gravity lessened positions then progressing against gravity as tolerated.
  • Submaximal isometric shoulder IR/ER/ABD/flexion/extension
  • RROM hand, wrist, elbow
Contraindications/Precautions:
  • No shoulder RROM.
  • No lifting objects.

Strengthening Phase (8-15 weeks ):

Goals:
  • Full AROM.
  • 4+/5 RC scapular stabilizers.
Contraindications/Precautions:
  • No RROM IR/ER rotation at 90 degrees unless supine/prone.
  • No heavy lifting especially above shoulder level.
Rehab to include:
  • RROM rotator cuff shoulder flexion, ABD, IR/ER.
  • Scapular stabilization RROM.
  • Continue PROM/AROM to achieve full ROM.
  • Progress to functional position, strengthen rotator cuff at 90 degrees ABD supine/prone.
  • Endurance training (UBE).

Advanced Functional Strength Phase (16 weeks-on):

Goals:
  • Independent long term HEP.
  • Return to normal function and sports activities.
Rehab to include:
  • Aggressive RROM rotator cuff functional position Ex: IR/ER at 90 degrees ABD.
  • Plyometrics.
  • Sports specific, work specific training

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