PT Protocols

Arthroscopic Anterior Capsulolabral Reconstruction

Phase I: Immediate post-operative phase (Restrictive motion)

Goals:

  • Protect the anatomic repair
  • Prevent negative effects of immobilization
  • Promote dynamic stability
  • Decrease pain and inflammation 

Weeks 0 to 4

  1. Sling for 4 weeks
  2. Sleep in immobilizer for 4 weeks
  3. Elbow and hand ROM exercises
  4. Hand gripping exercises
  5. ***No active ER or extension or abduction
  6. No passive or active motion at the shoulder
  7. Cryotherapy and modalities as indicated

Week 4

  1. Discontinue sling at 4 weeks
  2. May use immobilizer for sleep
  3. ROM exercises (PROM and AAROM)
    1. Flexion to 90-110
    2. Abduction to 75-85
    3. ER in scapular plane to 15-20
    4. IR in scapular plane to 55-60
  4. Progress ROM and initiate AROM after 4 weeks
  5. Continue modalities and cryotherapy

Weeks 5 to 6

  1. Gradually improve ROM
    1. Flexion:  140
    2. ER at 45 degrees abduction:  25-30
    3. IR at 45 degrees abduction:  55-60
  2. PNF manual resistance   
  3. May initiate gentle stretching
  4. Posterior Capsular Stretching

Phase II:  Intermediate phase (Moderate protection)

Goals: 

  • Gradually restore full ROM
  • Preserve the integrity of the surgical repair
  • Restore muscular strength and balance

Weeks 6 to 10

  1. Gradually progress ROM
    1. Full flexion
    2. ER at 90 abduction:  45-70
    3. IR at 90 abduction:  60-70
  2. Initiate exercise tubing ER and IR (arm at side)
  3. Initiate isotonic dumbbell exercises for deltoid, supraspinatus, up to 3 lbs. max (once full AFE is achieved)
  4. PNF strengthening

Weeks 10 to 14

  1. Slightly more aggressive strengthening
  2. Continue all stretching exercises
  3. ***Progress ROM to functional demands

Phase III:  Minimal protection phase

Goals:

  • Establish and maintain full ROM
  • Improve muscular strength, power and endurance
  • Gradually initiate functional activities

Criteria to enter Phase III:

  1. Full pain-free ROM
  2. Satisfactory stability
  3. Strength improving
  4. No pain or tenderness

Weeks 14 to 18

  1. Continue all stretching exercises
  2. Continue strengthening exercises
    1. Fundamental throwing exercises
    2. PNF manual resistance
    3. Endurance training
    4. Initiate light plyometrics
    5. Light swimming
  3. Initiate plyometric program (if needed)
    1. Do not begin until 5/5 MMT for rotator cuff and scapula.  
    2. QD at most
    3. Begin with beach ball/tennis ball progress to weighted balls
      1. 2-handed tosses: overhand
        • Underhand
        • Diagonal
      2. 1-handed stability drills
      3. 1-handed tosses (vary amount of abduction, UE support, amount of protected ER) 

Weeks 18 to 20

  1. Continue all above exercises
  2. Initiate ITP

Phase IV:  Advanced strengthening phase

Goals:

  • Enhance strength, power and endurance
  • Progress functional activities
  • Maintain shoulder mobility

Criteria to enter Phase IV:

  1. Full pain-free ROM
  2. Satisfactory static stability
  3. Strength 75-80% of contralateral side
  4. No pain or tenderness

 Weeks 20 to 24

  1. Continue flexibility exercises
  2. Continue isotonic strengthening program
  3. PNF manual resistance patterns
  4. Plyometric strengthening
  5. Progress ITP

Phase V:  Return to activity phase (6 to 9 months after surgery)

  1. Gradually progress sport activities to unrestricted
  2. Discharge/Return to sport criteria
    1. PROM WNL for ADL’s/work/sports
    2. MMT 5/5 shoulder girdle and/or satisfactory isokinetic test
    3. Complete plyometric program, if applicable
    4. Complete interval return to sport program, if applicable