Acute Phase (0 - 6 weeks):

Precautions:
  • Avoid active range of motion for 6 weeks.
  • Avoid resisted range of motion for 8 weeks.
  • Avoid external rotation greater than 45 degrees for 4 weeks.
  • No passive elevation greater than 90 degrees for 3 weeks.
  • Continued use of sling until physician states otherwise.
Therapeutic Exercises:
  • Elbow, wrist, and hand active and resisted motion to tolerance.
  • Pendulum exercise.
  • Passive forward flexion and abduction less than 90 degrees until 3 weeks then as tolerated (pulleys and cane rocking are acceptable).
  • Passive external rotation range to 45 degrees at 0 degrees abduction for 4 weeks then as tolerated.
  • Gentle internal rotation (behind the back) and extension to tolerance.
  • Isometric scapular retraction and depression.
  • Passive range of motion with therapist within precautions.

Six Weeks Postop:

  • Continue active assisted and passive range of motion into forward flexion and abduction to tolerance achieving full range of motion.
  • External rotation to tolerance at 0 and 45 degrees abduction.
  • Active range of motion in all planes. Start gravity lessened, progress against gravity as tolerated.
  • Begin submaximal isometric abduction, external rotation, internal rotation, and extension from neutral position.

Eight Weeks Postop:

  • Advance external rotation range of motion to full available at 90 degrees abduction.
  • Initiate light isotonic rotator cuff and scapular stabilization.
  • UBE

Twelve Weeks Post-op:

  • Return to full range of motion.
  • Maximize strength.
  • Progress rotator cuff strengthening to functional positions as tolerated.

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