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Isolated Slap Debridment or Repair - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full shoulder AROM
  • Protect long head of biceps
  • Strengthen in painfree ROM, emphasize rotator cuff/scapular stabilization musculature
  • Instruct in use of sling for comfort, icing, hand gripping, elbow and shoulder ROM
  • Educate Patient on post-op compliance to ensure best functional outcome


Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.


Phase I (Post-op Weeks 1-3)

  • NO RESISTED BICEPS X 6 WEEKS
  • No Running
  • Sling (for comfort). Wean as tolerated
  • Hand squeezing exercises
  • Elbow and wrist AROM
  • Submax isometrics all planes (maintain 90° elbow flex and NO BICEPS)
  • May begin AAROM and AROM shoulder exercises with pendulum, wand, wall walks, etc. THE FIRST WEEK POST-OP: do not “push through” any sharp pain
  • Ice 20 mins 3-5 times/day for the first week, then PRN after that


Goals: Control/reduce pain and inflammation, allow soft tissue healing, avoid loading long head of biceps, AROM shoulder: 40 degrees ER, 120 degrees flex and abduction, full IR, full elbow, hand and wrist ROM


Phase II (Weeks 4-6)

  • NO RESISTED BICEPS X 6 WEEKS
  • Progress shoulder PROM/AAROM to tolerance
  • UBE forward and backward
  • Posterior capsule and posterior rotator cuff stretching
  • Scapular mobilizations
  • Scapular strengthening exs: shrugs/rows/retraction/pushouts (“punches”)
  • Level I Dynamic stabilization exercises for scapula: gentle weight shifting with hands on wall, progress to hands and knees weight shifting
  • Light tubing exercises for all shoulder directions
  • Stationary bike
  • Walking on treadmill (may start jogging progression if debridement only)


Goals: AAROM: Flex 160 degrees, Abd 160 degrees, ER 60 degrees, IR to T10, Pain control, no scapular adhesions


Phase III (Weeks 7-12)

  • Continue previous exercises to increase flexibility, strength and proprioception
  • May need to be more aggressive with stretching. Therapist may add mobilizations, or other techniques as needed.
  • Gradually progress elbow flexion strengthening
  • Gradually progress shoulder flexion/biceps tendon strengthening
  • Progress the tubing/weights as tolerated
  • If no pain, initiate Level II Dynamic stabilization exercises: supine tubing pertubations, single arm weight shifting on hands and knees, PNF, rhythmic stabilization, ball on wall, BAPS, small Body Blade: start with 2 hands,
  • Plyoback: 2 hands only and at chest level.
  • Wall pushups….progress to table, then bent knees
  • Pool program for strengthening and ROM/stretching
  • Gym program when tolerated
  • Bike/Treadmill/jogging progression


Goals: Full AROM shoulder: Normal GH joint ROM and scapulothoracic rhythm, full AROM elbow, 30 table pushups, normal shoulder strength

Phase IV (Weeks 12+)

  • Continue previous exercises to increase flexibility, strength and proprioception
  • Regular push-ups
  • Initiate sports-specific or work-specific drills/tasks
  • Throwing progression
  • Continue gym progression
  • May begin swimming progression

Goals: Resume all activities (pain free) by 6 mos, normal shoulder pain free ROM and strength, normal arthrokinematics


No contact sports until 6 months post-op (Repair) or 3 months post-op (debridement) unless cleared by physician.

 

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