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Goals

• Maintain integrity of repair
• Diminish pain and inflammation
• Prevent muscular inhibition
• Independent with ADL’s with modifications while maintaining the integrity of the repair.

Precautions

• No active range of motion (AROM) of Shoulder
• Maintain arm in sling, remove only for exercise
• No lifting of objects
• No shoulder motion behind back
• No excessive stretching or sudden movements
• No supporting of body weight by hands
• Keep incision clean and dry
• Continue use of brace / sling
• Pendulum Exercises (to begin 21 days after surgery, no pendulums before this time)
• Start passive ROM to tolerance (at 21 days)
  • Flexion
  • Abduction in the scapular plane
  • ER in scapular plane
  • IR in scapular plane
• Continue Elbow, wrist, and finger AROM / resisted
• Cryotherapy as needed for pain control and inflammation

Goals

• Allow healing of soft tissue
• Do not overstress healing tissue
• Gradually restore full passive ROM (week 4-5)
• Decrease pain and inflammation

Precautions

• No lifting > 10 Ibs
• No supporting of body weight by hands and arms
• No excessive behind the back movements
• No sudden jerking motions

Criteria for progression to the next phase (III):

• Full AROM

Week 5-6

• Discontinue use of brace / sling full time at end of week 4
• Initiate active-assisted range of motion (AAROM) flexion in supine position
• Progressive passive ROM until approximately Full ROM at Week 4-5.
• This ROM should be PAIN FREE
• Gentle Scapular/glenohumeral joint mobilization as indicated to regain full passive ROM
• Continue previous exercises in Phase I as needed
• Continue all precautions
• Initiate prone rowing to neutral arm position
• Continue cryotherapy as needed
• May use heat prior to ROM exercises
• May use pool (aqua therapy) for light ROM exercisesIce after exercise

Week 6-8

• Continue AAROM and stretching exercises
• Begin rotator cuff isometrics
• Initiate active ROM exercises
  • Shoulder flexion scapular plane
  • Shoulder abduction

Goals

• Full AROM (week 10-12)
• Maintain Full PROM
• Dynamic Shoulder Stability
• Gradual restoration of shoulder strength, power, and endurance
• Optimize neuromuscular control
• Gradual return to functional activities

Precautions

• No heavy lifting of objects (not > 10 Ibs.)
• No sudden lifting or pushing activities
• No sudden jerking motions

Criteria for progression to the next phase (IV):

• Able to tolerate the progression to low-level functional activities
• Demonstrates return of strength / dynamic shoulder stability
• Re-establish dynamic shoulder stability
• Demonstrates adequate strength and dynamic stability for progression
• Continue stretching and passive ROM (as needed)
• Dynamic stabilization exercises
• Initiate strengthening program
  • External rotation (ER)/Internal rotation (IR) with therabands/sport cord/tubing
  • ER Sidelying-Lateral Raises*
  • Full Can in Scapular Plane* (avoid empty can abduction exercises at all times)
  • Prone Rowing
  • Prone Horizontal Abduction
  • Prone Extension
  • Elbow Flexion
  • Elbow Extension

Week 12:

• Continue all exercise listed above
• Initiate light functional activities

Week 14:

• Continue all exercise listed above
• Progress to fundamental shoulder exercises

Goals:

• Maintain full non-painful active ROM
• Advance conditioning exercises for Enhanced functional use of UE
• Improve muscular strength, power, and endurance
• Gradual return to full functional activities

Week 16:

• Continue ROM and self-capsular stretching for ROM maintenance
• Continue progression of strengthening
• Advance proprioceptive, neuromuscular activities

Week 20:

• Continue all exercises listed above
• Continue to perform ROM stretching, if motion is not complete

Goals:

• Gradual return to strenuous work activities
• Gradual return to recreational activities
• Gradual return to sport activities
• Continue strengthening and stretching
• Continue stretching, if motion is tight