Penrose Physical Therapy
01
Jan 2016
Jennifer Penrose
Author
Jennifer Penrose
PHASE I (0-6 WEEKS)

*Sling used

Restrictions:

  • Week 1
    • 120° FLEX
    • 20° ER
    • 75° ABD
  • Week 2
    • 140° FLEX
    • 40° ER
    • 75° ABD
    • NO active IR, EXT

ROM:

  • Codman/pendulum exercises
  • PROM to limit
  • Capsular stretches: ANT, POST, INF
  • AAROM: FLEX, EXT IR, ER
  • Progress to AROM as tolerated

Strengthening: Grip strength only

Criteria to progress to phase II:

  • Minimal pain and tenderness
  • Almost full ROM
  • Intact subscapularis w/o evidence of tendon pain on resisted IR
PHASE II (6-12 WEEKS):

Restrictions:

  • Increase ROM goals:
    • 160° FLEX
    • 60° ER
    • 90° ABD

ROM:

  • Goals as above
  • Increase AROM in all directions
  • Passive stretching
  • Joint mobilizations for capsular restrictions

Strengthening:

  • RTC strengthening 3x/wk to prevent RTC tendonitis
    • Closed chain isometrics
      • ER
      • ABD
    • Progress to open-chain with theraband
      • Concentric: ER, ABD, FLEX
      • Eccentric: ER, ABD, FLEX
    • Isotonic dumbbell exercises
      • ER, ABD, FLEX
    • Scapular stabilizer strengthening
      • Scapular retraction/protraction
      • Scapular Depression & shrugs
PHASE III (3-12 MONTHS):

ROM:

  • ROM equal to opposite side
  • Utilize both AROM & PROM exercises to maintain motion

Strengthening:

  • Begin IR & EXT strengthening
  • Scapular stabilizing strengthening
  • Deltoid strengthening
  • Plyometric exercises

References:
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Philadelphia, PA: The Curtis Center; 2003.

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