Post-Operative Rehabilitation Protocol

Arthroscopic Posterior Shoulder Stabilization

Weeks 0-3
  • Patient is immobilized in a S.C.O.I. brace for the first 3 weeks post-operatively
  • The brace should be worn 24 hours/day for the first 3 days post-operatively
  • Beginning on POD #4, the patient may remove the brace for approximately 30 minutes per day to shower; otherwise, the brace should be worn at all times
  • Begin ball squeezes
Weeks 3-6
  • Patient no longer required to wear the brace
  • Use modalities as needed (ice, heat, electrotherapy, etc.)
  • Begin gentle passive ROM exercises in all directions
    • Gentle with internal rotation; NO cross body adduction
  • Begin isometric internal and external rotation exercises with arm at side and elbow flexed to 90 degrees as patient's pain tolerance allows; isometric flexion and extension may be added as needed
  • Add active-assist ROM exercises (wand exercises); ROM limited by pain
    • Gentle with internal rotation; NO cross body adduction
  • Add gentle joint mobilization as needed
  • Add shoulder shrug exercises
Weeks 6-9
  • Continue passive and active-assist ROM exercises
    • May begin gentle cross-body adduction
    • May add wall climbs for shoulder flexion/abduction
  • Continue isometric exercises as above
  • Begin IR/ER strengthening exercises with adducted arm (arm at side) using rubber tubing (Thera-band)
  • Begin active IR strengthening with free weights with adducted arm and elbow flexed to 90 degrees
  • Begin UBE comfortably at 60 rpm
    • Add supraspinatous exercise if movement is pain-free and adequate ROM exists (0-90 degrees)
      • o Shoulder is positioned in the scapular plane approximately 20-30 degrees forward in the coronal plane
  • Add active shoulder flexion through pain-free ROM
  • Add active shoulder abduction to 90 degrees as tolerated
  • Continue shoulder shrugs and scapular strengthening
Weeks 9-12
  • Continue active and passive ROM exercises
    • Try to regain full active and passive ROM by 12 weeks post-operatively
  • Continue isotonic strengthening exercises with emphasis on the rotator cuff and posterior deltoid
  • Proprioceptive neuromuscular facilitation (PNF) may be added as needed
    • Emphasis on the flexion/abduction/ER diagonal; start ¼ of the way in the diagonal in an effort to protect the posterior capsule from excessive stress
Weeks 12-16
  • Patient may resume upper body workouts in gym; start at very easy/low intensity level and gradually progress to more intense work-outs
    • Gradually progress in exercises that stress the posterior capsule (flat bench press, military press, push-ups)
  • Continue to progress strengthening as tolerated
    • Emphasis on eccentric phase of contraction of the rotator cuff
  • Begin active horizontal adduction
  • Add total body conditioning program
Weeks 16-24
  • Should have full ROM in all directions
  • Continue total body conditioning program
  • Begin sport-specific activity and skills
    • Throwing athletes may begin the throwing program
RETURN TO SPORTS

THROWING SPORTS: May begin progressive shoulder throwing program at 4 months post-op if patient has achieved full ROM and approximately 80% strength

CONTACT SPORTS: No contact sports (such as tackle football, snow skiing, water skiing, wrestling, martial arts) until 6 months post-op and greater than 90% strength and endurance