Note: This pathway is designed to serve as a guide to rehabilitation. Indications for progression should be based on patient’s complete operative procedure, functional capacity and response to treatment.

Initiation of PT:

  • 2-4 weeks PO
  • Dictated by surgeon

Sling Wear

  • 24/7 x 4 weeks

Rehabilitation Phase | Phase 1 | Weeks 1-6 Post-Operative

  • PROM guided by pain
  • Supine self PROM flexion (90 deg)
  • Table wash
  • AROM Elbow/wrist/hand
  • Continue modalities (reduce inflammation and pain)

Precautions/Limitations

  • No lifting
  • External rotation at 90 degrees abduction limited to 45 degrees through 6 weeks
  • No push-up type exercises/bench press/military press x3 months. Then start light and slow as tolerated
  • Forward flexion limited to 90 degrees thru 6 weeks

Goals

  • Pain-free AAROM
  • Reduce muscle atrophy
  • Decrease pain and inflammation

Rehabilitation Phase | Weeks 4-6 Post-Operative

  • PROM progressed as tolerated
  • AAROM progressed as tolerated
  • Prone Clocks
  • CKC exercises
    • Horizontal (table)
    • Vertical (wall)
  • Scapular stabilization exercises
  • Continue GH inferior mob (grade 2)
  • Continue wrist and elbow PRE’s
  • Sub maximal isometrics
  • Initiate trunk exercises
  • Continue modalities as necessary
  • UBE 0 resistance

Goals

  • Pain-free PROM/AAROM
  • Decrease pain and inflammation

Rehabilitation Phase | Phase II | Weeks 6-8 Post-Operative

  • DC sling, start AROM
  • Normalize AROM (full in all planes)
  • Low resistance UBE forwrd/backward
  • Scapular stabilization exercises: elevation, depression, retraction, protraction in lateral stance position with involved hand on wall
  • Initiate tubing 6 weeks (punch, pull, ER, and IR)
  • Protected loading (modified push-ups on wall, ball on wall)
  • Initiate isotonic (increase wt) ER at 0
  • Continue inferior mob (+and/posterior mob as indicated)
  • Prone Clock (start without wt first)
  • Proprioceptive and manual control drills
  • Continue modalities pro
  • Instruct postural exercises

Goals

  • Increase muscular strength
  • Min-0/10 pain
  • Improve neuromuscular and proprioceptive control (i.e. body blade)
  • Normal scapulohumeral rhythm

Rehabilitation Phase | Phase III | Weeks 8-12 Post-Operative

  • Eccentric cuff and scapular exercise as need
  • Forward elevation to 170 (full can-thumb up)
  • UE plyometric drills (2 handed)
  • Chest press, push-ups, serrates push-ups in protected ROM
  • Diagonal patterns with LE reaches
  • UE endurance exercises
  • Running/treadmill running progressions (if appropriate)

Rehabilitation Phase | Phase IV | Weeks 12-16 Post-Operative

  • Start functional activities/exercises
    • Overhead sport program initiated 12-14 weeks per approval of physician
  • Advance 1 arm plyometrics
  • Weight training, light weight
  • Return to sport programs 4-6 months
  • Contact sports 8-12 months, or on physician clearance

DC Goals

  • 0-3/10 pain scale
  • Min-to-0 palpable tenderness on clinical exam
  • Transition to home/gym HEP
  • AROM WFL all planes
  • Strength 4 to 4+/5 depending on skill level and ADL’s