Rehab Shoulder Posterior Instability Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Rehab Shoulder Posterior Instability Protocol

Phase I: (0-4 weeks)

Goals:

  • Protect surgery
  • Decrease pain and inflammation
  • Initiate safe ROM while protecting posterior capsule
  • Patient education

Plan:

  • PROM limited to 90° of flexion and abduction/No Horizontal adduction
  • 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 adduction with internal rotation***

Plan:

  • Begin increasing forward elevation (flexion in scapular plane) beyond 90° and general glenohumeral mobility without stressing posterior capsule.
  • Joint mobilization avoid aggressive mobs/avoid posterior mobs
  • (Internal rotation directions/horizontal adduction)
  • Use caution when performing passive range of motion into abduction with external rotation and internal rotation so as not to stress the healing capsule.
  • AAROM.
  • Aquatic Therapy.
  • Gentle rotator cuff strengthening, emphasis posterior cuff and horizontal abductors.

**Check with physician on rotation limitations**

Phase III (8-16 weeks)

Goals:

  • Near full ROM: EXCEPT ADDUCTION/INTERNAL ROTATION
  • Good scapulo-humeral rhythm
  • 80-90% strength

Plan:

  • PROM (full range; ER AND IR near full-range):
  • **No FORCE IN ADDUCTION/INTERNAL ROTION
  • 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