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

Precautions:
  • Avoid active shoulder elevation.
  • 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 elevation beyond 90 degrees 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 to tolerance at 0 and 45 degrees of abduction.
  • Flexion and abduction AAROM and PROM limited to 90 degrees.
  • Light sub maximal isometric abduction, external rotation, internal rotation, and extension.

Intermediate Phase (weeks 4-5)

  • Discontinue use of sling.
  • Progress flexion and abduction PROM, AAROM, and AROM to tolerance beyond 90 degrees elevation.
  • Begin internal rotation flexibility and AAROM behind the back to tolerance.
  • Start AROM to tolerance in all planes of motion beginning in gravity lessened positions and progressing against gravity as tolerated.
  • Continue sub maximal isometric flexion, abduction, external rotation and extension.
  • Progress PROM in all planes to full.

Strength Phase (weeks 6-9):

  • Continue progressive PROM and AAROM all planes to achieve full shoulder ROM.
  • Continue AROM exercises.
  • Start progressive resisted exercise shoulder flexion, abduction, external and internal rotation, horizontal abduction and adduction. Do not go beyond neutral horizontal adduction.
  • Start rhythmic stabilization exercise: internal and external rotation at 0 degrees, 45 degrees, and 90 degrees abduction and flexion and extension at 90 degrees flexion, horizontal abduction and adduction 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 operatively.

Advance Strength and Stabilization (weeks 10-11):

  • Continue progressive resisted exercise as above.
  • Start rotator cuff strengthening at 90 degrees 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.

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