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.
- 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.
Twelve Weeks Post-op:
- Return to full range of motion.
- Maximize strength.
- Progress rotator cuff strengthening to functional positions as tolerated.