Phase I: (0-4-6 weeks)
Goals:
- Protect surgery
- Decrease pain and inflammation
- Initiate safe ROM while protecting anterior/posterior capsule
- Patient education
Plan:
- PROM limited to 90° of flexion and abduction: Do NOT stress or force internal and external rotation.
- Elbow and wrist ROM
- Modalities PRN
- Pendulum and scapular activities
- Light resisted activity to wrist
Phase II (4-6 weeks to 8-10 weeks)
Goals:
- Decrease pain and inflammation
- Achieve 50-80% of full ROM of flexion, extension and IR at end of phase
**This DOES NOT include abduction with ER or horizontal adduction w/ IR**
Plan:
- Discontinue sling at 1 month
- Begin increasing forward elevation (flexion in scapular plane) beyond 90°
- Joint mobilization: avoid aggressive mobs/avoid inferior, anterior; and posterior directions
- Use caution when performing passive range of motion into abduction with external rotation and internal rotation so as not to stress the healing capsule.
- Scapular PNF
- AAROM
- Aquatic Therapy
- Gentle rotator cuff strengthening (ER to neutral)
**Check with physician on rotation limitations**
Phase III (8-10 to 16-24 weeks)
Goals:
- Near full ROM: EXCEPT ABDUCTION w/ EXTERNAL ROTATION and HORIZONTAL ADDUCTION with INTERNAL ROTATION
- Good scapulo-humeral rhythm
- 80-90% normal strength
Plan:
- PROM (full range; ER near full-range):
- Joint mobilization
- Progressive scapular strengthening
- Progressive rotator cuff ~strengthening
- Begin machine weighted exercise
- Gentle PNF, eccentric cuff strengthening
- Biodex training if requested by M.D.
**NO FORCE IN ABDUCTION/EXTERNAL ROTATION
**NO FORCE IN ADDUCTION with INTERNAL ROTATION
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