Anterior and Posterior Capsular Shift and Superior Labral Repair Protocol

Initial Protective Phase (0-4 weeks post-operative)

• No active shoulder elevation until 4 weeks post-op. (if there was no superior labral repair active shoulder elevation is allowed.)
• Continue use of sling unless the arm is supported while sitting.
• No internal rotation behind the back until 4 weeks post op.
• No shoulder horizontal adduction until 4 weeks post op.
• No passive elevation beyond 90 degrees until 4 weeks post op.
• No external rotation beyond 45 degrees at 0 degrees abduction until 4 weeks post op.

Therapeutic Exercise (weeks 1-4)

• Full AROM elbow, wrist and hand.
• Codman pendulum exercise.
• External rotation PROM, AAROM, and AROM limited to 45 degrees at 0 degrees abduction.
• Flexion and abduction AAROM and PROM limited to 90 degrees.
• Light sub maximal isometric abduction, external rotation, internal rotation, extension, and scapular retraction.

Intermediate Phase (weeks 4-5)

• Discontinue use of sling.
• Progress flexion and abduction PROM and AAROM as tolerated beyond 90 degrees elevation.
• Initiate flexion and abduction AROM to tolerance.
• Progress external rotation ROM as tolerated beyond 45 degrees at 0 and 45 degrees abduction.
• Initiate internal rotation flexibility and AAROM behind the back to tolerance.
• Initiate AROM to tolerance in all planes of motion beginning in gravity lessened positions and progressing against gravity as tolerated.
• Progress sub maximal isometric flexion, abduction, external rotation, extension and scapular retraction.
• Progress PROM in all planes as tolerated.

Strength Phase (weeks 6-9)

• Continue progressive PROM and AAROM in all planes to achieve full shoulder ROM.
• Initiate external rotation and internal rotation ROM as tolerated at 90 degrees of abduction.
• Continue AROM exercises.
• Initiate progressive resisted exercise shoulder flexion, abduction, external and internal rotation, horizontal abduction and adduction. Do not go beyond neutral horizontal adduction.
• 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).
• Begin horizontal adduction flexibility if needed at 8 weeks post-operative.

Advance Strength and Stabilization (weeks 10-11)

• Continue progressive resisted exercise as above.
• Initiate rotator cuff strengthening at 90 degrees of abduction.
• Progress closed chain stabilization exercise against body weight (i.e. table pushups progressing to floor, swiss ball stabilization).

Advanced Plyometric and Throwing Phase (week 12)

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