his protocol is intended to be a general outline only. The physician reserves the right to either advance or delay this protocol as deemed necessary. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery.

 

0-4 Weeks Post-Op: Patient to be seen 2-3x/week

Guidelines:

  • No isolated biceps activation
  • Use of Ultrasling 4 weeks
  • No use of operative arm for lifting, pushing or pulling of objects
  • Keep incisions clean and dry until told by physician to get wet
  • No massage directly over operative area
  • Ice several times/day for control of pain and inflammation

Goals:

Decrease pain, protect repair.  Achieve gradual PROM – prohibit elbow hyperextension or overstretching.  Promote scapular mobility

 

At Week 1: 

  • Pendulum exercises, shoulder shrugs, scapular retraction, scapular depression.
  • PROM elbow flexion/extension, wrist supination/pronation, AROM hand exercises (ball squeezes).
  • Begin light aerobic exercise (bike, walk) while wearing sling for cardiovascular fitness.

 

At Week 2:

  • Shoulder pulley exercises for AAROM in planes of flexion and scaption
  • PROM all shoulder planes, within pain tolerance
  • Scapular isometrics, lawnmowers, table lifts

 

At Week 4: 

Discontinue Ultrasling.

  • Submaximal (50% effort) isometrics for shoulder musculature in standing or supine and progress.
  • Scapular mobilization in sidelying to promote proper scapulohumeral rhythm
  • Prone shoulder retraction and extension to neutral
  • Core strengthening exercises as indicated to promote proximal stability
  • Scar massage once wound is healed to avoid adhesions.

 

Week 5-9: Patient seen 2-3x/week

Precautions: NO lifting, pushing, or pulling.

Goals: Full shoulder and elbow ROM.

  • Begin gradual AROM below the shoulder at 8 weeks and above the shoulder at 12 weeks.
  • Light weight functional activities at waist level may begin at 8 weeks
  • Continue above exercises,
  • At Week 6, begin sidelying ER to 30° without weights
  • At Week 8, add towel stretch or sidelying