Post-Operative Rehabilitation Protocol

Arthroscopic Anterior Shoulder Stabilization

Weeks 0-3
  • Patient remains in a sling for at least 3 weeks post-operatively
  • Patient comes out of sling daily to perform rehabilitation exercises
  • Patient may discontinue sling once good muscular control of shoulder is achieved (usually between 4-6 weeks post-operatively)
  • Caution patient to avoid abducted, externally rotated, and extended position
  • Begin passive exercises: pendulums, rope and pulley exercises (flexion only), wand exercises (flexion only)
    • Limit passive external rotation to 45 degrees; internal rotation as tolerated
  • Begin isometric exercises: abduction, external rotation, biceps, triceps (avoid biceps if concomitant SLAP repair)
  • Patient may begin the following active assist exercises: supine forward elevation assisted with normal arm; ROM limited by pain
  • Patient may begin the following active exercises: elbow flexion and extension (no active elbow flexion if concomitant SLAP repair)
  • Putty for grip strengthening
Weeks 3-6
  • Continue active exercises as in weeks 0-3
  • Continue active assist exercises as in weeks 0-3
  • Continue isometric exercises as in weeks 0-3
  • Continue passive exercises as in weeks 0-3
    • Do NOT allow external rotation beyond 60 degrees with the arm in the adducted position (arm at side); do not push beyond pain tolerance
    • Continue to avoid externally rotated and abducted position
Weeks 6-9
  • Continue active exercises as above
  • Continue active assist exercises as above
  • Continue isometric exercises as above
  • Continue passive exercises as above
    • Continue to avoid externally rotated and abducted position
    • ROM goals to achieve by 9 weeks post-operatively: 150 degrees flexion, 60 degrees external rotation, 80 degrees internal rotation
  • Begin IR/ER strengthening exercises with adducted arm (arm at side) using rubber tubing (Thera-band)
  • Begin the following strengthening exercises with 1-2 pound weights: forward flexion, prone extension (do not allow arm to pass behind plane of body during prone extension), empty can, deceleration
  • Begin scapular strengthening: seated rows, shrugs, wall push-offs
  • May institute contract-relax techniques, mobilization techniques, etc. if required to meet ROM goals
  • UBE (cable column)
    • Biceps (gently progress if concomitant SLAP repair), triceps, lat pull down (narrow hand grip, pull down in front)
Weeks 9-12
  • Continue active and passive ROM
    • Try to regain full ROM in flexion, extension, IR, ER (with arm by side), and adduction by 12 weeks post-operatively
    • Avoid abducted, extended, externally rotated stretch
  • Progress strengthening program with addition of the following:
    • UBE (cable column): seated rows, punches, biceps, triceps, horizontal
    • Push up program: start with kneeling push-ups, then progress to regular push-ups (avoid push-ups with elbow flexion past 90 degrees and extension past neutral; "stop push-up halfway down")
    • Begin plyoball routine emphasizing chest passes; progress gradually to single arm throws without "cocking"
    • Standing stabilization exercises with tubing, arm elevated in diagonal pattern
Weeks 12-24
  • Patient may resume upper body workouts in gym; start at very easy/low intensity level and gradually progress to more intense work-outs
    • Avoid the abducted/extended/externally rotated position (during bench press, incline press, and military press)
  • Continue strengthening program
  • May begin progressive throwing program when adequate strength achieved (OK to put arm in "cocked" position for throwing)
  • Add total body conditioning program
RETURN TO SPORTS

THROWING SPORTS: May begin progressive shoulder throwing program at 3 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