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

Precautions:
  • No active shoulder elevation until 4 weeks post-op.
  • Continue use of sling with abduction pillow unless the arm is supported while sitting.
  • No shoulder horizontal adduction or horizontal abduction until 4 weeks post op.
  • No passive abduction 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 (0-4 weeks post-operative):

  • Full AROM elbow, wrist and hand.
  • Codman pendulum exercise.
  • PROM/AAROM scaption to 90 degrees, ER to 45 degrees at 0 degrees ABD, flexion as tolerated.
  • Light flexibility and AAROM internal rotation behind the back.
  • Scapular elevation and retraction.

Intermediate Phase (4 weeks post-operative):

  • Discontinue use of sling.
  • PROM/AAROM scaption and flexion as tolerated.
  • AROM: scaption – supine at 4 weeks, standing at 5 weeks, side- lying ER,prone row, extension at 4 weeks.
  • PROM/AAROM ER at 0 abduction as tolerated.
  • Progress sub maximal isometric flexion, abduction, external rotation, extension and scapular retraction.

Strength Phase (6 weeks post-operative):

  • 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 8-10):

  • 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 (weeks 10-12):

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

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