Post-Operative Therapy for SLAP Repair/Bankart Repair

Post-Operative Therapy for SLAP Repair/Bankart Repair

(Adapted from Wilk/Andrews/Neer/Jobe)

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.

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