PHASE ONE

At this stage the most important goals are patient education and gentle ROM. The tissues are healing and the focus should be on positioning and postures that place the least amount of stress on the tissue.

Sling: To be worn for 3 weeks at all times and for five weeks while sleeping or out in public. It may be beneficial to use a pillow for support while sleeping once the sling is removed. When your sling is off your elbow should remain by your side.

Ice: 2-3 times daily for 10-15 minutes to decrease the inflammation and help to control pain

Physical Therapy: Start physical therapy Ix week for 6 weeks at 10-14 days post-op. At six weeks post-op physical therapy should be twice a week for 10-14 weeks.

Remember that these guidelines should take into account the patient's symptoms and one should not progress to the next stage if the patient cannot successfully complete the previous one.

Week two-four weeks

Small Pendulums/Tummy Rubs Elbow/ Wrist Range of motion
Posture awareness and scapular retraction with out resistance Supine PROM flexion and ER to 30 degrees in the scapular plane Grade I-II Joint mobs
Standing Saws - elbow not past the body PROM Limits: Flex to 90
ER to 30 in scapular plane
IR to 60 in scapular plane

Week four-six

Add AAROM (wand) in supine (flex, IR, ADD, ER in scapular plane) Grade II-III Jt. Mobs and add cross body Adduction
4-point weight bearing for scapular neuromuscular facilitation (wt shift; serratus push up) Rhythmic stabilization beginning in neutral arm position
Bent over rows, Retraction with shoulder ext. to body for scapular stability
Resisted Add and Ext in standing and rows with light resistive band or low pulley
weights
Light isometrics in Add, Abd, IR, Flex, Ext with bolster under arm. ROM limits: Flexion to 140
ER to 40
IR to full

PHASE TWO

The focus at this stage is to normalize ROM and promote normal scapulohumeral mechanics while strengthening and stabilizing the shoulder complex.

Week six-eight

Progress to full PROM except Abduction to 90 Progress isometrics
Progress to side-lying ER with bolster
Increase Wt bearing exercise with rhythmic stabilization and unstable surfaces (foam, Bosu, Swiss Ball)
Add horizontal abduction to 50% of normal
Begin Manually resisted stabilization in supine arm at 90 or in scapular plane
Begin Body Blade in non provocative positions ... arm at side

PHASE THREE

The focus at this stage is to further progress rotator cuff and scapular muscle strength for proper mechanics and stability through the entire ROM.

Week eight-twelve

Prone flexion (low trap)
Progress Body Blade with more elevation where tolerable
Increase AROM and cue proper scapular mechanics, PNF patterns with weights, pulleys and to bands if tolerated at the end of the phase
Progress wt bearing exercises with more unstable surfaces, Wobble boards, airex, bosu ball, etc
Advance push-ups from wall to table level then continue toward the floor as tolerated
Progress strengthening above 90 degrees when tolerable
Catch and Toss with the Medicine ball
UBE

PHASE FOUR

The focus at this stage is to prepare for return to occupation, sport or desired activities as the Tissues mature and are ready to handle the increased load.

Work or sport specific exercises Standing PNF with resistive bands
Advance plyometrics with Medicine Balls, single Arm
Overhead Body Blade Activity
Work hardening
Gradual return to sport or desired activity (throwing program etc.)

Even though the individual may be feeling good and want to return to his/her activity, the tissue continues to mature and it may take 12 months for that process to occur. The majority will return to their activity in approximately 6 months depending upon the repair.