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.

Protective Phase | Phase I – Immediate Motion Phase | Weeks 0-7

Weeks 0-2

  • Sleep in immobilizer for 4 weeks
  • Immobilizer 24hours/day except for PT
  • Elbow and Hand ROM
  • Hand griping exercises
  • Gentle shoulder AAROM exercises with T-bar or cane
    • Flexion to tolerance (90 degrees max)
    • ER and 20 degrees Abduction – to tolerance (maximal motion 15-20 degrees)
    • IR at 20 degrees Abduction – to tolerance (maximal motion 45 degrees)
    • Rope and Pulley
  • Isometrics for ER, IR, abduction, biceps with arm at side (0 degrees abduction)
  • Cryotherapy and modalities as needed

Weeks 3-4

  • Discontinue use of immobilizer except for sleep
  • Continue gentle ROM exercises with T-bar (cane)
    • Flexion to tolerance (maximal 120-140 degrees)
    • ER (45 degrees abduction) – acceptable 20-30 degrees
    • IR in (45 degrees abduction) – acceptable 45-60 degrees
    • Initiate light isotonic for shoulder musculature – abduction, supraspinatus, ER, IR and biceps
    • Initiate scapular strengthening exercises with emphasis on trapezius and serrates anterior
    • Continue use of cryotherapy

Weeks 5-6

  • Gradually improve Rom with T-bar (cane)
    • Flexion to maximum 160 degrees
    • ER at 90 degrees abduction: 45-60 degrees (maximum)
    • IR at 90 degrees abduction: 65-75-60 degrees (maximum)
  • Diagonal patterns, manual resistance
  • Rhythmic stabilization progression
  • Progress all strengthening exercises in neutral position

Rehabilitation Phase | Phase II – Intermediate | Weeks 8-14

Weeks 8-10

  • Progress to full Rom (weeks 8-10)
    • Flexion to 180 degrees
    • ER at 90 genres abduction: (90 degrees)
    • IR at 90 degrees abduction: (85 degrees)
  • Continue to progress isotonic strengthening program
  • Continue all scapular strengthening
  • Initiate isokinetic exercise program in neutral if available

Weeks 10-14

  • Continue all flexibility exercises, self-capsular stretches
  • Throwers 10 program
  • Diagonal pattern manual resisted exercise programs
  • UBE 90 degrees abduction

Rehabilitation Phase | Phase III – Advanced Phase | Months 4-6

  • Continue all stretching exercises (capsular stretches)
  • Maintain throwers motion (especially ER)
  • Continue throwers 10 program
  • Isokinetic ER/IR (90-90 position)
  • Plyometric exercises
    • May begin interval throwing program when approved by physician

Rehabilitation Phase | Phase IV – Return to Activity | Months 6-9

  • Aggressive strengthening program for shoulder and scapular musculature
  • Continue throwers 10 program
  • Progress interval throwing
  • Begin unrestricted throwing