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Preoperative Guidelines

• Restore AROM
  
• Strengthen involved extremity in pain free ROM, emphasize rotator cuff/scapular stabilization musculature
  
• Instruct in use of abduction pillow immobilizer, icing, hand gripping, elbow ROM
  
• Educate Patient on post-op protocol and importance of compliance for good outcomes

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 Day 1 – Week 3)

• No ER past neutral, no IR, no extension ROM
  
• Immobilizer with abductor pillow x 2 wks: must be worn all the time, even at night
  
• Begin scar massage once incision site sloughs/scar is formed
  
• Hand squeezing exercises
  
• Elbow and wrist AROM
  
• Gentle pendulum in small ranges: no extension, ER or IR
  
• PROM/AAROM in supine with wand or assist of other hand
  
  • Flexion to 90 degrees
    
  • Abduction to 90 degrees
    
• Supervised pulley to 90 degrees flexion and abduction
  
• Shoulder shrugs, scapular retraction exercises
  
• Begin stationary bike as tolerated
  
• Ice 20 mins 3-5 times/day for 5-7 days, then PRN
  
• Sleep with pillow under arm for comfort

Goals: Pain control, AAROM to 90 degrees in abduction and flexion, normal elbow & wrist ROM

Phase II (Weeks 4 – 6)

• Wean from immobilizer
  
• Continue scapular mobility exercises
  
• Standard pendulum
  
• Resisted elbow/wrist exercises (light dumbbell)
  
• AAROM Flexion and Abduction with wand or pulley in pain-free range
  
• May progress past 90 degrees as tolerated
  
• AAROM ER as tolerated
  
• AAROM IR as tolerated if no supscapularis repair
• May begin to put hand slowly behind back and slide up as tolerated
  
• 1-2 Finger isometrics
  
• Continue stationary bike

Goals – AAROM to 120 flexion and abduction, no scapular adhesions

Phase III (Weeks 7 – 9)

• UBE with low resistance forward and backward
  
• AROM, AAROM, stretching as needed
  
• Begin rotator cuff Theraband exercises: ER/IR at 0 degrees shoulder abduction, flexion and scaption (thumb up) to 90 degrees
  
• ER in sidelying
  
• Standing rows with Theraband
  
• Prone horizontal shoulder abduction/scapular retraction at 90 degrees
  
• Serratus anterior exercises: “Pushouts”
  
• Hands and knees weight shifting, ball on wall weight shifting
  
• Light ball Plyoback at chest level
  
• Continue stationary bike
  
• Pool walking/running – no UE resistive devices in pool

Goals – Full AROM shoulder with normal scapulothoracic motion

Phase IV (Weeks 10 – 12)

• Progress UBE
  
• PROM as needed to restore full functional ROM
  
• Con’t Theraband, free weights and scapular stabilization exercises with increased resistance as tolerated. Emphasize muscle fatigue. Perform all exercises to fatigue 3 times/week.
  
• Body Blade, BAPS, supine tubing perturbations for all directions
  
• Rhythmic scapular stabilization exercises
  
• Ball toss with arm at side using lightest ball
  
• Push-up progression against the wall
  
• Elliptical trainer
  
• Treadmill walking progression
  
• Pool therapy – with UE resistive devices

Goal – 50 wall push-ups, strength at least 4/5 rotator cuff muscles

Phase V (Months 4 – 6)

• Gym program: begin weight training starting with light resistance
  
• Continue push-up progression program: to table, to bent knees, to regular
  
• Continue strengthening and stabilization exercises as needed
  
• Gravitron – pull-ups and dips
  
• Begin functional training/ sports-specific drills:
  
  • Basketball – dribbling, pass and catch (no overhead), shooting in the key
    
  • Frisbee – throw and catch
    
  • Racquetball , tennis, ping pong – forehand and backhand (no overhead)
    
  • Football catch and underhand throw
    
  • Volleyball: bumping, setting and underhand serve
    
• When pain free, begin throwing progression and gradually work on overhead sports drills
  
• Pool – begin swimming laps
  
• May begin jogging

Goals: Shoulder strength WNL and equal bilaterally, 90% patient subjective rating, pain free functional/sports drills

No contact sports until 6 months post-op