Rehab Shoulder Anterior Instability Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Rehab Shoulder Anterior Instability Protocol

Anterior Instability Protocol (Post op anterior reconstruction)

Phase I: (0-2 weeks)

Goals:

  • Protect surgery: Limit ER to 45 degrees and abduction to 90 degrees
  • Decrease pain and inflammation
  • Initiate safe ROM while protecting anterior capsule
  • Patient education

Plan:

  • ROM limited to 90° of flexion and abduction only
  • Elbow and wrist ROM
  • Modalities PRN
  • Pendulum and scapular activities
  • Light isometric activity
  • Light resisted activity to wrist

Phase II (4-6 weeks)

Goals:

  • Decrease pain and inflammation
  • Achieve 60-80 of full ROM of flexion, extension and IR.

*****This DOES NOT include abduction/ER*****

Plan:

  • Discontinue sling at 1 month
  • Begin increasing forward elevation (flexion in scapular plane) beyond 90°
  • Joint mobilization: avoid aggressive mobs/avoid inferior and anterior; external rotation directions
  • AAROM
  • Aquatic Therapy
  • Gentle rotator cuff strengthening (ER to neutral)

**Check with physician on rotation limitations**

Phase III (8-16 weeks)

Goals:

  • Near full ROM: EXCEPT ABDUCTION/EXTERNAL ROTATION
  • Good scapulo-humeral rhythm
  • 80-90% normal strength

Plan:

  • PROM (full range; ER near full-range):

**NO FORCE IN ABDUCTION/EXTERNAL ROTATION

  • Joint mobilization
  • Progressive rotator cuff ~strengthening
  • Begin machine weighted exercise
  • Gentle PNF, eccentric cuff strengthening
  • Biodex training if requested by M.D.

Phase IV (>24 weeks)

Goals:

  • Maximum ROM
  • Increase strength
  • Return patient to sport/activity

Plan:

  • Continue with progressive resistive exercises
  • Continue with machine weighted program
  • Sport Specific Training

PT sig:

Discontinue sling at 1 month
Limit ER to 45 degrees and abduction to 90 degrees
ROM and strengthening per protocol