General considerations
- Use of a sling only as needed or prescribed – Okay to shower once dressings are changed (Day 1)
- Arm is restricted from these movements for 4 weeks:
- extension (backwards) past the plane of the body
- External rotation (arm rotation outwards) greater than 0° (straight in front); extensive repairs may require more restrictions
- For posterior repairs, avoid any internal rotation (turning in) past the body
- No passive forceful stretching into external rotation/extension for 3 months following an anterior repair and into internal rotation for a posterior repair
- Good posture is critical throughout the rehabilitation process to improve healing and decrease the risk of developing poor mechanics
- Aerobic conditioning throughout the rehabilitation process
- M.D./nurse followups Day 2, Day 14, 1 month, 4 months, 6 months and 1 year.
- All active exercises should be carefully monitored to minimize substitution or compensation
Week 1
- Nurse visit Day 2 to inspect surgical dressing and review home program.
- Ice shoulder every 2 hours for 1520 min during wake hours for first 2 weeks.
Manual:
- effleurage
- soft tissue mobilization to surrounding musculature
- gentle scapula glides.
Exercise:
Home program to consist of:
- Elbow flexion / extension
- wrist and forearm strengthening
- cervical stretches
- postural education and exercises.
*It is important to come out of the sling frequently to bend and straighten elbow for 10-15 repetitions each time to minimize arm and hand swelling.
Stationary bike, stair machine, and Versa Climber without putting weight on arms.
Goals:
- Decrease pain and edema.
- Initiate passive range of motion to shoulder per restrictions (anterior no ER/Ext, posterior no IR).
- Passive range of motion < 50 degrees flexion/scaption.
- Full elbow range of motion.
Weeks 2-4
Manual:
- effleurage
- soft tissue mobilization to surrounding musculature
- gentle scapula glides.
- Pain control(i.e. cryotherapy, massage, and electric stimulation).
Goals:
- Decrease pain and edema.
- Passive range of motion < 90 degrees flexion/scaption.
Weeks 4 – 6
MD appointment at 4 weeks, discharge sling if approved by MD.
Manual:
Soft tissue mobilization to surrounding musculature, initiate scar mobilization to surgical incisions if completely closed.
Exercise:
Passive and active assisted flexion out to the scapular plane as tolerated (cane exercises, wall walking,table slide).
- Progress to active exercises from flexion into the scapular plane against gravity as tolerated
*No resistance until able to perform 30 reps with perfect mechanics. - Isotonic wrist, forearm, and scapular exercises.
- Theraband resisted pulldowns from the front and the scapular plane; elbow flexion; submaximal isometrics (as dictated by pain); active scapular elevation, depression, and retraction exercises; light weight bearing
- Upper body ergometer with light to no resistance only.
- Add proprioceptive training (alphabet writing, fine motor skills, work / sport specific).
Goals:
- Out of sling; minimal resting pain.
- Initiate active range of motion flexion/scaption.
Weeks 6 – 8
Manual:
Continue with soft tissue mobilization, range of motion.
Exercise:
- Continue to increase active range of motion exercises as tolerated (serratus anterior, upper and lower trapezius); add eccentrics into protected ranges.
- Okay to begin LIGHT stretching into external rotation.
- Okay to begin LIGHT glenohumeral joint mobilization.
- Okay to add light resistance internal rotation exercises from 0 degrees to the body only
- Increase proprioceptive training (prone on elbows, quadruped position / “on all four’s”for rhythmic stabilization).
- Upper body ergometer (UBE) with increasing resistance.
Goals:
- Range of motion greater than 80% of normal, initiate tolerance to hand behind head/back exercises.
- Initiate jogging, road cycling, and standing arm resistance exercises in the pool.
Weeks 8 – 12
- Emphasis on regaining strength and endurance.
- Light proprioceptive neuromuscular facilitation (PNF) patterns.
- active range of motion exercises to include internal rotation and external rotation as motion allows, lateral raises and supraspinatus isolation, rower with a high seat, decline bench press, military press in front of body.
- Running, road or mountain biking; no activities with forceful, ballistic arm movement.
3 – 6 Months:
MD appointment at 12 weeks.
- Aggressive stretching; begin strenuous resistive exercises.
- Add light throwing exercises with attention to proper mechanics.
6 Months:
- Increase throwing program/sport-specific program. Focus on return to sports as mechanics, conditioning, and strength allow.
Source: The Stone Clinic
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