POST – OPERATIVE PHASE I (WEEKS 2-4)
MAXIMUM PROTECTION PHASE
GOALS:
- Promote healing: reduce pain, inflammation and swelling
- Elevation in plane of scapula: to 90 E External Rotation: to 30 E Initiate restoration of humeral head and scapular control
- Independent home exercise program
TREATMENT RECOMMENDATIONS:
AAROM elevation in plane of scapula to 90 E ER to 30 E scapular mobility and stability (sidelying, progressing to manual resistance), sub-max deltoid isometrics in neutral (3-4 wks), sub-max RC isometrics in neutral (3-4 wks), elbow/ wrist AROM, gripping exercises, modalities for pain and edema, prn
Emphasize patient compliance to HEP and protection during ADLs
PRECAUTIONS:
- Immobilizer at all times when not exercising
- Internal Rotation and Horizontal Adduction limited to neutral
MINIMUM CRITERIA FOR ADVANCEMENT:
- External Rotation to 30 E Minimal pain or inflammation
Emphasize:
- PROTECTING SURGICAL REPAIR
- Limiting horizontal adduction and IR to neutral
- Patient compliance with sling immobilization
POST – OPERATIVE PHASE II (WEEKS 4-6)
GOALS:
- Continue to promote healing
- Elevation in plane of scapula to 90 E Internal Rotation to 45 E Begin to restore rotator cuff strength to 4/5
TREATMENT RECOMMENDATIONS:
D/C immobilizer (MD directed), AAROM elevation in plane of scapular and ER, progress scapular strengthening protecting posterior capsule (modify closed chain exercises), sub-maximal isometrics ER/IR, sub-maximal deltoid isometrics, modalities for pain and edema, prn, progress HEP
PRECAUTIONS:
- Limit Internal rotation to 45 E Horizontal adduction limited to neutral
- Protect posterior capsule
- Avoid rotator cuff inflammation
MINIMUM CRITERIA FOR ADVANCEMENT:
- Minimal pain and inflammation
- Elevation in plane of scapula to 90 E Internal rotation/ external rotation strength
Emphasize:
- PROTECTING SURGICAL REPAIR
- Monitoring ROM
- Avoiding excessive stretch to posterior capsule
- Avoiding inflammation of rotator cuff
POST – OPERATIVE PHASE III (WEEKS 6-12)
GOALS:
- Restore full shoulder range of motion
- Restore normal scapulohumeral rhythm throughout ROM
- Upper extremity strength 5/5
- Restore normal UE flexibility
- Isokinetic IR/ER strength 85% of unaffected side
TREATMENT RECOMMENDATIONS:
Initiate AAROM IR, continue AAROM for ER and elevation on plane of scapula, continue progressive scapula strengthening, protecting posterior capsule, initiate IR/ ER in modified neutral, begin latissimus strengthening, begin scapula plane elevation when RC and scapula strength is adequate, humeral head stabilization exercises, PNF patterns if IR/ ER is 5/5, isokinetic training and testing, UE endurance (UBE), initiate flexibility exercises, modalities prn, modify HEP
PRECAUTIONS:
- Avoid rotator cuff inflammation
- Continue to protect posterior capsule
- Avoid excessive passive stretching
MINIMUM CRITERIA FOR ADVANCEMENT:
- Pain-free
- Full upper extremity range of motion
- Normal scapulohumeral rhythm
- Normal upper extremity flexibility
- IR/ER strength 5/5
- Isokinetic IR strength 85% of unaffected side
Emphasize:
- PROTECTING SURGICAL REPAIR
- Avoiding excessive passive stretching
- Avoiding inflammation of rotator cuff
- Establishing normal scapula and rotator cuff strength base
POST – OPERATIVE PHASE IV (WEEKS 12-18)
GOALS:
- Restore normal neuromuscular function
- Maintain strength and flexibility
- Isokinetic IR/ER strength to the unaffected side
- > 66% Isokinetic ER/IR strength ratio
- Prevent Re-injury
PRECAUTIONS:
- Pain free plyometrics
- Significant pain with a specific activity
- Feeling of instability
- Avoid loss of strength and instability
- Avoid overtraining
TREATMENT RECOMMENDATIONS:
Full UE strengthening emphasizing eccentrics, UE flexibility program, advance ER/IR strength to 90/90 position (overhead athlete), isokinetic training and testing, continue endurance training, initiate plyometrics, sport and activity related program, address trunk and LEs as required, modalities prn, modify HEP
CRITERIA FOR DISCHARGE:
- Pain free sport or activity specific program
- Isokinetic IR/ER strength at least equal to unaffected side
- > 66% Isokinetic ER/IR strength ratio
- Independent Home Exercise Program
- Independent sport or activity specific program
- Eccentric strengthening for overhead athlete
- Elimination of strength deficits
- Restoration of ER/IR strength ratio
- Restoration of flexibility to meet demands of sport activity
*Please note: The instructions for rehabilitation protocols are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Allen or his staff should supersede the instructions above and should be followed. If you have questions regarding your rehabilitation protocol, please contact a member of our team.
