This 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.
- Ice pack should be used upon arriving home from surgery. Use ice for 15 minutes, 3-4 times a day.
- Bulky dressings can be removed the day after surgery, and band-aids placed over steri-strips. Steri-strips should be left in place until they fall off.
- Begin basic exercises the day after surgery: pendulum, shoulder shrugs, elbow curls, grip strengthening.
- Sling should be worn at all times while awake for the first 2 days. After that, continue wearing sling up to 5 days post-op as needed for pain control.
Week 0 – 1 Post-Op
Patient seen for first visit ~3 days post-op. Frequency: 2 – 3x/week.
- Continue HEP of pendulum, shoulder shrugs, elbow curls, and grip strengthening
- PROM of shoulder in all directions
- Cane AAROM in supine for flexion, abduction, and ER
- Pulley AAROM exercises for flexion and abduction in plane of scapula
- Sidelying scapular isometrics, lawnmowers, table lifts
Week 1 – 4
Frequency: 2 – 3x/week until full ROM achieved, then decrease frequency as indicated.
Goal: Full PROM flexion and ER by end of Week 4
- Continue shoulder PROM, pulley and cane exercises
- Prone periscapular exercises within pain free ROM
- Begin wall walking AAROM
- Once full PROM is achieved, begin AROM in gravity-neutral positions, progressing to anti-gravity positions
Week 4 – 8
Goals: Full PROM and AROM in all planes by end of Week 8; initiate strengthening program.
- Once full AROM is achieved, begin PRE’s through advancing degrees of ROM
- Add resisted elastic and/or pulley exercises for deltoids, rotator cuff, and periscapular muscles
- Continue to promote normal scapulothoracic rhythm
- Add closed-chain exercises: scapular setting in quadruped, wall pushups, etc.
Week 8 to Discharge
Frequency: 1x every other week or as needed
Goal: Advanced strength and endurance of shoulder
- Continue increasing resistance for PRE’s
- Emphasize multi-planar and diagonal exercises
- Introduce sport-specific exercises, light plyometrics, throwing, etc.
Ultimate Goals for Rehabilitation and Discharge
Full pain-free ROM in all planes, full strength and endurance of shoulder, and return to all ADL’s and sports activity.