Goal
- Reestablish full function of shoulder without stressing anterior capsule.
- May return to contact sports and weightlifting at 6 months; full recovery may take 1 year
Phase I – Protective / Early Range of Motion (0 to 3 weeks)
Goals
- Early range of motion to prevent stiffness
- Allow healing of repair
Exercise (perform exercises 3 times daily)
- Active assisted flexion with pulleys – progressively increase to 90º
- Pendulums
- AAROM shoulder ER to neutral (0º). Use a cane or other hand.
- AROM of elbow (flex, extend, supinate, pronate), wrist, and hand (putty)
- NO ACTIVE ABDUCTION OR EXTERNAL ROTATION during first 6 weeks.
- Patient should wear sling .
Phase II – Recovery of Range of Motion (3 to 6 weeks)
Goals
- Improve range of motion
- Gentle strength
Exercise: (Isometrics should be sub maximal, sub painful contractions)
- Isometric ER with elbow at side and forearm on stomach
- Isometric abduction with elbow at side
- Isometric biceps flexion
- Increase AAROM flexion with pulleys to 140º
- Begin adduction stretching, with arm pulled across body
- Discontinue sling use at 6 weeks.
Phase III – Advanced ROM (6 to 9 weeks)
Goals
- Increased ROM
- Continue gentle strength
Exercise:
- AAROM ER with elbow at side to 40º
- AAROM abduction to 90º
- IR stretching (towel behind back, slide cane up back, etc.)
- Increase flexion with pulleys to equal other shoulder
Phase IV – Strength (9 to 16 weeks)
Goals
- Approaching full range of motion
- Clinic and home based strength program
Exercise:
- Rotator cuff strength. Progress as tolerated and as strength improves
- Upper Body Ergometer (UBE)
- Total Gym
- Lat pulls
- Seated Rows
- Plyoball rebounder
- Incline pushups
- Chair dips
- Increase active abduction to equal other shoulder
- Work on any focal deficits
Discharge (16+ weeks)
Goals
- Full active range of motion without pain
Exercise:
- Full, unrestricted activity
- Regular shoulder and rotator cuff strength as maintenance program