General Guidelines
PT will begin 2 weeks post-operatively
No weight bearing on operative arm
No glenohumeral external rotation past neutral for 8 weeks to protect subscapularis repair
Maintain surgical ROM early, don’t push it
No lifting anything heavier than a full coffee cup with the operative extremity
These precautions should be followed for the first 12 weeks post-operatively
ROM goals: 90 degrees at 2 weeks, 120 degrees at 3 weeks, 140 degrees at 4 weeks and then full range of motion.
Phase 1 (Weeks 0-2)
Goals:
Reinforce precautions
Control pain and inflammation
Instruct in home exercises for elbow, wrist, and hand – start immediately, maintain full elbow ROM
Begin postural exercises and shoulder activation
Begin Pendulums/Codman exercises at 2 weeks postop
Instruct in ADL’s, e.g. putting on/taking off sling and clothing
Instruct in bed mobility & transfers without weightbearing on operative arm
Precautions: As per the General Guidelines
Wear the sling at all times except for exercises, dressing, and showering
Patients may shower after 3 days – do not remove steri-strips, No soaking wound until 6 weeks and when incision completely healed with no drainage
Phase 2 (Weeks 4-6)
Goals:
Begin Pendulums/Codman exercises at 2 weeks postop
Control pain and inflammation
Start PROM with forward flexion and abduction – patient should be at 90 degrees of forward flexion and increase 10-20 degree each week (table slides, pendulums, passive elevation)
Work on postural exercises immediately
Begin light AAROM when tolerating (using stick/cane, pulleys, walk hand up wall)
Begin light scapular strengthening
Begin sub-maximal pain-free deltoid isometrics in scapular plane
Begin to wean from the sling to wear at night and while out of the house at 4 weeks.
Phase 3 (Weeks 6-12)
Goals:
Discontinue sling
Begin AROM against gravity in straight planes, i.e. no combined motions
Progress to light closed-chain exercises
Begin gentle glenohumeral IR and ER sub-maximal pain-free isometrics
Phase 4 (Beyond 12 weeks)
Goals:
Can begin AROM with combined motions against gravity
Begin light strengthening but no lifting greater than 6 pounds
Advance to functional activities to enhance function of operative extremity