Phase I (post-op until week 2) Protective phase
- Sling use for 0‐7 days as needed (or as directed by MD)
- Elbow and hand ROM and hand squeezing exercises
- Passive, AAROM, and AROM exercises as symptoms allow (starting with Passive.
- Patient tolerance will determine progression)
- Initiate shoulder isometrics and scapulothoracic re‐education and stabilization
- Control inflammation and pain
Phase II (weeks 2-6) Intermediate phase
Weeks 2-4
- Continue with ROM exercises (PROM/AAROM/AROM)
- Use of pool therapy if possible for ROM and shoulder strengthening
- Initiate gentle stretching exercises
- Normalize shoulder and scapulothoracic arthrokinematics
- Continue with isometric strengthening and begin with light total arm, rotator cuff and scapulothoracic stabilizer strengthening
- Control pain and inflammation
**Progression based upon: AROM = forward flexion 90 degrees +, abduction 70 degrees+, ER in scapular plane 30 degrees, tolerance of current exercises and ADL’s, and patient compliance with home exercises and precautions
Weeks 4-6
- Continue with ROM exercises with focus on increasing to full ROM
- Progress with stretching exercises
- Advance with shoulder rotator cuff, scapular stabilizers and total arm
- strengthening(begin with no resistance and progression to weights and tubing), sidelying ER, and prone strengthening, and full can scaption
- PNF with light manual resistance and rhythmic stabilization
- UBE for strengthening and endurance training with proper scapulothoracic and shoulder positioning
- Initiate joint mobilization (G/H, A/C, S/C, S/T) and posterior capsular stretching
- Avoid compensatory patterns with strengthening (adjust as necessary with less reps or decreased resistance)
**Progression based upon: AROM = forward flexion 150 degrees +, abduction 140 degrees+, ER in scapular plane 40 degrees, tolerance of current exercises and ADL’s, and patient compliance with home exercises and precautions
Phase III (Weeks 6-10) Strengthening Phase
- Full ROM (AAROM and AROM)
- Continue with stretching
- Continue to progress with strengthening ( scapular stabilizers, rotator cuff musculature, flexion and abduction movements, triceps and biceps)
- Open and closed chain exercises and perturbation training
- Rhythmic stabilization
- Light initiation to sport activities as appropriate and patient tolerates
**Progression based upon full pain free ROM to functional demands, strength deficits less than 25%, good quality shoulder and scapulothoracic stabilization
Phase IV (Weeks 11+) Advanced Strengthening Initiation of Sport Activity
- Continue with stretching exercises
- Advanced strengthening (including overhead strengthening, isokinetic ER/IR strengthening at 90 degrees of abduction, increased isotonic training)
- Endurance training
- Rhythmic stabilization in all ranges and positions
- Manual PNF resistance
- Advanced closed kinetic chain exercises
- Sport specific training
**Progression based upon pain free tolerance to training, strength deficits less than 10% throughout, completion of training program, and confidence in shoulder