– Maintain surgical motion early, but don’t push it.
– Protect the subscapularis repair: No internal rotation resistance until at least 4 ½ months.
– Strengthen the surrounding musculature.
– Alternate between pool and land therapy.
– Minimize heavy, excessive cyclic loads for the first 6 months.
– No pulleys in first 6 weeks.
– No resistance until 4 ½ months, except for periscapular muscles. This is a gradual progression, not a stepped progression
Outpatient Rehab Phase I 0-3 weeks post op
o On except for:
Shower: Most have subcuticular closure with glue and may shower immediately.
– PROM (Performed by Therapist, not to exceed surgical rom)
o FLEX, ER to neutral – minimize reps (5-10)
o Therapist PROM should NOT be excessively painful. If it is STOP
o Encourage Patient PROM
– Pendulums and Codman’s ex’s
– Towel Slides or equivalent
– Pool for PROM.
– General conditioning (stationary bike, treadmill, etc)
– Maintain hand strength
– Maintain normal motion at the elbow/wrist
– Maximum ER to Neutral
3-6 weeks post op.
o Wear at night and when out of house
o Don’t use arm to push up out of chair
– Supine AAROM (not to exceed surgical rom)
o FLEX, ABD, ADD, IR with towel, start ER at 6 weeks (minimize reps 5-10).
– Pool for PROM and AAROM (water is the assistance)
o Use combined motions and teach fluidity of movement.
o 10 reps with combined movements in pool.
– Light scapular strengthening (i.e. scapular setting, gentle MR scap protraction and retraction).
– Gentle joint mobilization and soft tissue mobilization to restore normal scapular mobility. – Nerve glides as necessary
Phase II 6-12 weeks
– Discontinue sling
– Continue with PROM.
– More AAROM on land
o Progress from SUPINE to SEATED, then to STANDING position.
– At 6 weeks begin AROM on land, against gravity (straight planes only, no combined motions.)
– Pool – continue
o AAROM and AROM
– Can begin pulley work and NOT BEFORE.
– Progress to some light closed-chain proprioceptive ex’s (wall washing)
– Arm bike with no resistance.
– Gentle jt mobes to restore normal accessory glide motion in shldr girdle if necessary.
Phase III 12-18 weeks post op
– Can begin AROM with COMBINED MOTIONS at 3 months (on land, against gravity).
– Begin light strengthening o Begin strengthening for lats, rhomboids, biceps/triceps, pecs, and deltoids.
– Pool – continue
o Use floats and paddles for resistive work in the pool.
– Increase scapular strengthening with theraband and light weights.
– Add more advanced proprioceptive ex specific for work, ADL’s and sport.