Post-Operative Therapy for SLAP Repair/Bankart Repair
Adapted from Wilk/Andrews/Neer/Jobe
Note: This protocol 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.
- Call us at (916) 365-2987
- Schedule an Appointment
General Considerations
Guidelines for progression depending on healing timeframe for anatomic repair and performance of any concomitant procedures and/or co-morbidities (RCR/biceps repair)
Restrictive Phase
Weeks 0-3
Goals: Protect anatomic repair, prevent deleterious effects of immobilization, decrease pain and inflammation.
- Gentle PROM flexion 0-60° week 2, 60-75° week 3
- Elevation in scapular plane to 60°
- ER in scapular spine to <15°
- IR in scapular plane to <45°
- May initiate grade I/II scapular mobilization in all plans
- Elbow/Hand AROM and gripping activities
- No AROM or isolated biceps activation
- Sling to be utilized 24 hours a day, first 4 weeks
Modalities:
- Cryotherapy
- Pulsed US/phonophoresis
- IFC/HVGS, MHP
Moderate Protective Phase
Weeks 4-6
May discontinue use/wean off sling during the day.
Continue to wear sling at night until 6 weeks post-op.
ROM: PROM/AAROM
- Flexion/Scaption
- Week 4: 0-90°
- Week 5: 0-120°
- Week 6: 0-150°
- External rotation (ER)
- Week 4: 0-30°
- Week 5: 0-45°
- Week 6: 0-60°
- Abduction
- Internal rotation (IR) in scapular plane, as tolerated
- Elbow and wrist full ROM
Therapeutic Exercises:
- ROM
- Pendulums
- Pulleys (flexion and caption)
- Wand exercises into flexion, ER per ROM units
- Supine post cuff stretch into horizontal adduction
- Gentle Grade I/II glenohumeral and scapular joint mobs
- Manual stretching per ROM limits
- Strengthening
- Sub-maximal isometrics for IR/ER week 4, progressing to light Theraband IR/ER at neutral abduction by week 6
- No restricted elbow flexion or resisted shoulder flexion for 6 weeks
- Periscapular stabilization (H/M/L rows, prone rows, prone horizontal abduction)
- Initiate dynamic stabilization/proprioceptive activity
- No isolated biceps contraction
Minimally Protective Phase
Weeks 7-12
Goals: Gradually restore full ROM, preserve anatomic repair, improve muscle recruitment, normalize scapula-humeral rhythm, enhance joint proprioception.
- ROM:
- Flexion/Scaption – 150° progressing to full PROM by weeks 7-9
- Full PROM in ER in scapular plane, progressing to 90/90 position
- IR full by week 7-9
- Grade III scapular mobilizations, all ranges
- Grade III-IV, GH posteroinferior glides
- Strengthening:
- IR/ER with elastic resistance in neutral abduction (use a towel roll between the upper arm and side)
- Dumbbell isotonic exercises: flexion, scaption (full can), deceleration in sidelying (Thrower’s Ten)
- Rhythmic stabilization/contract-relax
- UBE (upper body ergometry)
- Scapular stabilization (H/M/L rows, shrugs, serrates punches)
- PNF (proprioceptive neuromuscular facilitation) with light manual resistance
- Bicep curls initiated at 6 weeks. Start with 3-5 pounds, progress cautiously
- Week 8 initiate chest pass plyometrics, progressing to overhead pass and diagnostics
Functional Phase
Weeks 12-16
Goals: Maintain full active ROM, progress strengthening and stabilization program and to prepare for specific functional drills.
- Continue previous ROM and mobilization technique to maintain full ROM
- Continue with elastic IR/ER resistance exercises, progressing reps, intensity and sets
- Progress from neutral to scapular to the 90/90 position
- Initiate rhythmic stabilization to the 90/90 position as patient progresses
- Progress dumbbell program (up to 5 pounds) progressing to move difficult positions (prone caption thumb up, horizontal abduction thumb up, extension palm down and ER in horizontal abduction)
- Continue with scapular strengthening/stabilization, progressing the push-up plus program
- Week 10 gradually progress to single arm throw, elbow extend, arm straight overhead, progressing slowly to “cocked” position
Weeks 12-24
- Strengthening and condition, as tolerated
- Sports specific exercises
- Overall-be smart about biceps work – don’t overload
Return to Functional Activities (use as guide as progress allows)
- Sedentary job – 3 weeks
- Manual job within reason – 3 months
- Driving – 6-8 weeks
- Golf – 3 months
- Lifting – avoid heavy lifting minimum 3 months
- Contact sports – 3 months minimum
- Overhead lifting/traction activities – as tolerated, 4 months, include pull-ups
- Throwing activity – 4 months post-op, follow appropriate return to throwing programming
- Dips – 4 months, as tolerated
- Return to sport – 4 months
- Return to full throwing – 5-6 months
