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Preoperative Guidelines
- Restore full shoulder AROM
- Strengthen in pain free ROM, emphasize rotator cuff/scapular stabilization musculature
- Instruct in use of sling, icing, hand gripping, elbow ROM, and pendulum exercises.
- Educate Patient on post-op compliance to ensure best functional outcome
Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.
Phase I (Post-op Days 1-7)
- No running x 8 weeks
- Sling x 4 wks – even while sleeping
- Supported pendulum exercises
- 1-2 finger (submax) isometrics all planes
- Hand squeezing exercises
- Elbow and wrist AROM
- Stationary bike
- Ice pack PRN
- Sleep with pillow under arm for comfort
Goals – Pain control, full ROM elbow/wrist/hand
Phase II (Weeks 2 – 4)
- No running x 8 weeks
- Continue sling x 4 wks
- Continue appropriate previous exercises
- Shoulder shrugs/scapular retraction without resistance
- Supine AAROM flexion to 90 degrees only
- Supine AAROM abduction to 60 degrees only
- AAROM ER as tolerated
- 1-2 Finger isometrics – 6-way, pain-free
Goals: Supine AAROM: flex 90 degrees, abd 60 degrees, full ER, pain control, no scapular adhesions
Phase III (Weeks 5 – 6)
- No running x 8 weeks
- D/C sling at 4 weeks
- Pendulum exercises
- Continue supine AAROM flex to 90 degrees and abd to 60 degrees only
- Light Theraband:
- External and Internal rotation with pillow or towel roll under arm
- Flexion, Extension, Abduction, Adduction to 60 degrees max
- Scapular retraction/rowing exercises with Theraband
- Supine triceps strengthening with light weight
- Biceps curls with light weight
- Treadmill – Walking progression program
Goals: Normal biceps/triceps strength, at least 4+/5 rotator cuff strength
Phase III (Weeks 7 – 8)
- No running x 8 weeks
- Schedule Gym Program appointment
- Continue appropriate previous exercises
- Supine AAROM to 90 degrees flex and abd
- Rotator cuff PREs with Theraband/weights
- Level I Dynamic stabilization exercises for scapula: gentle weight shifting with hands on wall, progress to hands and knees weight shifting, Plyoback with chest pass (2 hands)
- Body blade (smaller size). Start with 2 hands and progress to one. Increase endurance
- Push-ups against wall – hands below shoulder level
- UBE
- Elliptical trainer
- Treadmill – Continue walking program
Goals: Normal rotator cuff strength, Supine AAROM to 90 degrees flex and abd, Walk 2 miles at 15 min/mile pace
Phase IV (Weeks 9 – 12)
- Continue appropriate previous exercises
- Progress rotator cuff strengthening
- AAROM to tolerance with wand, pulley, wall climb – full range
- AROM in pain-free range
- Level II Dynamic stabilization exercises: supine tubing perturbations, single arm weight shifting on hands and knees, PNF, rhythmic stabilization, ball on wall, BAPS, large Body Blade, Plyoback progression, Fitter
- Prone horizontal shoulder abduction PREs
- Rowing on Total Gym level 1-3
- Ball toss with arm at side, progress gradually to overhead if no pain.
- Push-up progression – Wall to table, to knees
- Stairmaster
- Treadmill – Begin jogging progression
- Pool therapy
Goals – Full ROM GH joint with normal scapulothoracic rhythm, 30 bent knee pushups, jog 2 miles
Phase V (Months 3 – 6)
- Advance weight training program (Continue gym progression)
- Initiate sports-specific or work-specific drills/tasks
- Throwing progression
- Push-ups – regular
- Continue aerobic conditioning
- Swimming
Goals: Resume all activities (pain free) by 6 mos, normal shoulder pain free ROM and strength, normal arthrokinematics
No contact sports until 6 months post-op
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