SHOULDER INSTABILITY REPAIR – PHYSICAL THERAPY PROTOCOL

The rehabilitation program will be individually tailored by the therapist in close communication with the surgeon. You will start physical therapy on the second day after surgery (from Phase I). Please, be sure to make appointments in advance to begin physical therapy in time.

***Rehabilitation for arthroscopic instability repairs will vary considerably among patients and progression of therapy will be dictated on a regular basis by the surgeon through regularly scheduled clinic appointments****

Phase I: Passive/Active Assisted Motion: Day 2 – 6 weeks

• Wear the arm sling (If SLAP repair wear sling for 4 weeks)

• No weight bearing with the operative arm

• Active range of motion of elbow, wrist and hand out of sling

• First 2 weeks: Passive/active assisted external rotation with cane or stick with shoulder abducted to 30 degrees in supine (with towel roll under elbow) up to the neutral rotation. Passive/active assisted shoulder flexion in scapular plane in supine, with assistance of family member or therapist up to 90 degrees

• In the following 2 weeks: Increase external rotation up to 20 degrees and shoulder flexion up to 120 degrees

• In the following 2 weeks: Increase external rotation up to 30 degrees and shoulder flexion up to full flexion

• Home use of modalities as needed to assist in pain relief

Phase II: Active Assisted/Active Motion: 6 – 12 weeks

• Goal – Obtain full pain free passive and active range of motion

– Begin to restore proper scapulohumeral mechanics

– Independent ADLs

– Patient education/independence in home exercise program

• Discontinue the arm sling

• Continue AAROM – especially shoulder elevation with emphasis on correct shoulder biomechanics

• Progress to AROM as tolerated in pain-free ranges (begin with gravity lessened positions as appropriate)

• Add isometrics in pain-free ranges (especially flexion, external rotation, and medial rotation)

• Strengthen appropriate scapular muscles such as middle and lower trapezius.

• Patient education regarding home exercise program, posture, appropriate modification of activities

• Modalities as needed

Phase III: Strengthening: 12 weeks -24 weeks

(Must check with the surgeon prior to starting resistive strengthening)

• Goal – restore normal strength, gradual return to activity

• Continue AAROM/AROM as needed

• Improved scapulohumeral, scapulothoracic biomechanics

• Scapular muscle strengthening

• Theraband – Concentric and eccentric within pain free ranges, all planes (Note: keep elbow flexed to 90 degrees for flexion and elevate only to 90 degrees)

• Light free weights, aquatherapy as needed

• Progressively encourage patients to increase the functional use of the arm for light activities of daily living