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