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).
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 (2-4 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 4 weeks, no RTC RROM until 6 weeks.
  • No lifting, sudden movements or supporting of body weight with 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 scapulothoracic .
  • AROM/RROM hand, wrist, elbow.
  • AAROM/PROM shoulder flexion, ABD, IR, ER, to tolerance (rotation 0-45 ABD).
  • Flexibility apley IR.
  • Submaximal isometrics for scapular retraction/depression

Intermediate Phase (4-6 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, IR-70, ER-90 (rotation at 90 ABD) apley IR T10.
Contraindications/precautions:
  • No shoulder RROM until 6 weeks.
  • No lifting objects.
Rehab to include:
  • Continue PROM/AAROM.
  • Initiate Shoulder AROM starting in gravity lessened positions progressing to against gravity as tolerated.
  • Initiate sub-maximal shoulder isometrics in GH neutral for flexion, ABD, EXT, IR, ER.
  • RROM hand, wrist, elbow.

Strengthening Phase (6-12 weeks):

Goals:
  • Maintain full AROM.
  • 4+/5 RC, scap 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, scaption.
  • RROM scapular stabilization.
  • Progress to functional position, strengthen rotator cuff at 90 degrees ABD supine/prone.
  • Endurance training (UBE).
  • Continue scapular retraction .
  • Initiation of rhythmic stabilization training for IR/ER and FF/EXT.

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 structures in functional positions.
  • Plyometrics with volume progression.
  • Sport specific, work specific training.

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