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Preoperative Guidelines
- Restore full AROM
- Strengthen involved extremity
- Educate Patient on post-op protocol
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 Days 1 – 7)
- No extension past plane of the body x 4 weeks
- No running
- No ER > 0°
- Sling: Wear always, even at night. Maintain ER at 0°
- Hand squeezing exercises
- Elbow and wrist AROM
- 2-Finger isometrics (but No resisted rotation)
- Shoulder shrugs and scapular retraction and protraction
- Supported pendulum exercises
- Supine assisted shoulder flexion—use other arm to raise affected shoulder to 90°
- Stationary bike
- Ice pack 20 mins 3x/day
- Sleep with pillow under arm for comfort
Goals: Pain control, normal scapular mobility, PROM for shoulder flexion to 90°
Phase II (Weeks 2 - 4)
- No extension past plane of the body x 4 weeks
- No running
- No ER > 0°
- Continue sling while in public, but start to wean off
- Pendulum exercises
- Resisted elbow/wrist exercises (light dumbbell)
- Shoulder shrugs and scapular retraction and protraction
- Supine IR to 45° to 60° (w/arm abducted to 45°)
- Supine AAROM flexion and abduction to 90° only, progress to scapular plane
- 1-2 Finger isometrics: submaximal and pain free in all directions
- Continue stationary bike
Goals: Supine AAROM: Supine flex and abduction to 90°, Pain control
Phase III (Weeks 5 – 8)
- No Running
- Continue appropriate previous exercises
- AAROM: towel stretch, wand, pulley, wall climbs, etc. Do not “push through” any sharp, jabbing, or pinching” pain
- Light stretching into ER
- UBE: light resistance 10 minutes forward and 10 mins backward, increase resistance at 6 weeks
- Rotator Cuff exercises with Theraband: ER and IR at side flexion and scaption (thumb up) to 90°
- Scapular exercises: rows, shrugs and “push-out” exercises with Theraband, prone horizontal abduction at 90°
- Treadmill – Walking progression program
- Exercise bike, Stairmaster, Nordic Track, etc
- Pool exercises: jogging/shoulder ROM and gentle strengthening as above
Goals: 90% FAROM, pain free ADLs, at least 4/5 strength per MMT, 10 mins UBE without pain
Phase IV (Weeks 9-12)
- Continue appropriate previous exercises
- PROM as tolerated to restore near full functional ROM, aggressive stretching, GH Joint mobilizations prn
- UBE 15 min forward and 15 min back, gradually increase resistance
- Continue with Rotator cuff exercises: emphasis is on muscle fatigue every other day. Move progressively into higher shoulder ROM—bench press, military press in front of body
- Scapular stabilization and proprioception exercises:
- Rows on Total Gym (arms at sides and at 45°)
- Shrugs and Prone horizontal shoulder abduction (arm at 90°)
- Small circle rotations with Ball against wall
- Scapular protraction (push-up with a plus) against wall.
- Rhythmic stabilization/perturbations
- Body Blade
- BAPS on all 4s
- Plyoball progression
- Fitter on hands
- Push-up progression: Wall to table to chair to knees (no elbow flexion >90 degrees)
- Functional Training (Under PT’s supervision…Must be pain free and no overhead):
- Basketball—Dribble, pass and catch (no overhead), shooting in the key
- Frisbee – throw and catch
- Football catch and underhand throw
- Volleyball – bumping, setting, and underhand serve
- Racquet swings: forehand and backhand…No overhead
- Treadmill running progression
- Stairmaster, Elliptical trainer, stationary bike
- Progress with Pool Exercises
Goals: Full Shoulder AROM, normal strength per MMT, 50 push-ups on knees
Phase V (Months 3 – 6)
- Continue Rotator Cuff and scapular PREs: 3x/week and into the higher ROMs, but not in “at risk positions”.
- Sports specific drills: dribbling, passing, catching, shooting, rebounding, etc.
- Throwing progression
Goals: Pain free throwing
No contact sports until 6 months post-op
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