[fusion_builder_container hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” publish_date=”” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” admin_toggled=”no”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”3_4″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

The patient’s rehabilitation timeline will depend on intraoperative findings. An accelerated protocol can be followed if good bone and tendon quality are seen. Poor bone and tendon quality require reverting to a traditional rehabilitation protocol

The patient may progress as tolerated as long as he does not experience pain during or immediately after exercising. Some mild soreness after exercise can be expected.

Phase 1: Immediate postoperative period (weeks 0-1)

  • Goals
    • Maintain / protect the integrity of repair
    • Gradually increase AROM
    • Diminish pain and inflammation
    • Prevent muscular inhibition
    • Become independent with modified ADLs
  • Precautions
    • Maintain arm in sling for comfort. Can remove the arm as tolerated for exercises
    • No sudden jerking motions
    • Keep incision clean
  • Criteria for Progression to Phase 2
    • Active forward flexion to full
    • Active ER to full
    • Active IR to full
    • Active abduction to full in the scapular plane
  • Days 1 to 6
    • The sling should be worn for comfort
    • Pendulum exercises
    • Finger, wrist, and elbow AROM without weights
    • Begin scapula musculature isometrics / sets; cervical ROM
    • Cryotherapy for pain and inflammation
  • Days 3 to 6
    • Begin pulley exercises in forward flexion and abduction without restrictions
    • Maintain proper posture, joint protection, and positioning
  • Days 7 to 28
    • Continue wearing the sling as needed for comfort only
    • Pendulum / pulley exercises
    • Begin AROM to tolerance. No weight restrictions but must avoid rapid acceleration activities and / or loading of the biceps
    • ER in scapular plane
    • IR in scapular plane
    • Continue elbow, wrist, and finger AROM  with light resistance
    • Maximal isometrics for all cuff, periscapular, and shoulder musculature
    • Cryotherapy as needed for pain control and inflammation
    • May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin one week postoperative

Phase 2: Protection and active motion (weeks 1-6)

  • Goals
    • Allow healing of soft tissue
    • Do not overstress healing tissue
    • Full AROM
    • Dynamic shoulder stability
    • Gradual restoration of shoulder strength, power, and endurance
    • Optimize neuromuscular control
    • Gradual return to functional activities
    • Decrease pain and inflammation
  • Precautions
    • No sudden jerking motions
  • Criteria for progression to Phase 3
    • Full AROM
  • Weeks 3-4
    • Discontinue sling
    • Gradually improve AROM
      • Flexion and elevation in the plane of the scapula
      • Abduction to full
      • External / Internal rotation to full
      • Extension to tolerance
    • Continue cryotherapy as needed
    • May use heat before ROM exercises
    • Aquatherapy OK for AROM exercises
    • Ice after exercise
  • Weeks 5-6
    • Continue AROM and stretching exercises
    • Continue rotator cuff isometrics
    • Continue periscapular exercises
    • Gradually progress AROM
      • Flexion, elevation in the plane of the scapula to full
      • External rotation to full
    • Internal rotation to full
    • Extension to tolerance

    Phase 3: Advanced strengthening (weeks 7-12)

    • Goals
      • Maintain full non-painful AROM
      • Advance conditioning exercises for enhanced functional use
      • Improve muscular strength, power and endurance
      • Gradual return to full activities
    • Week 7
      • Continue ROM and capsular stretching for ROM maintenance
      • Continue progression of strengthening
      • Advance proprioceptive, neuromuscular activities
      • Light sports (golf chipping / wedges, tennis ground strokes) if doing well
      • Continue strengthening and stretching
      • Continue stretching if motion is tight
      • Initiate interval sports program (e.g., golf, doubles tennis) if appropriate

    AAROM = active assisted range of motion
    ADL = activity of daily living
    AROM = active range of motion
    ER = external rotation
    IR = internal rotation
    PROM = passive range of motion
    ROM = range of motion

[/fusion_text][fusion_separator style_type=”none” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” sep_color=”” top_margin=”50px” bottom_margin=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” /][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]