General Considerations:

•    Use of a sling only as needed or prescribed - Okay to shower once dressings are
     changed (Day 1)
•    Arm is restricted from these movements for 4 weeks:
•    extension (backwards) past the plane of the body
•    external rotation (arm rotation outwards) greater than 0° (straight in front); extensive
     repairs may require more restrictions
•    for posterior repairs, avoid any internal rotation (turning in) past the body
•    No passive forceful stretching into external rotation/extension for 3 months following
     an anterior repair and into internal rotation for a posterior repair
•    Good posture is critical throughout the rehabilitation process to improve healing and
     decrease the risk of developing poor mechanics
•    Aerobic conditioning throughout the rehabilitation process
•    M.D. follow-ups Day 1, Day 8-10, 1 month, 4 months, 6 months and 1 year
•    All active exercises should be carefully monitered to minimize substitution or
     compensation


1 - 5 days post-op:

•    M.D. office visit (Day 1) to change dressings and review home exercise program
•    Home program to consist of: - Icing shoulder as often as able for the first 3-5 days -
     Pendulums, elbow flexion / extension, wrist and forearm strengthening, gentle
     passive / active assistive exercises of the arm in flexion (front) keeping below the
     level of the shoulder, cervical stretches
•    Postural education and exercises
•    Stationary bike, stair machine, and VersaClimber without putting weight on arms for
     general conditioning
•    Sleeping semi-reclined is most comfortable


5 - 14 days:

•    Pain control (i.e. cryotherapy, massage, electric stim) - Gradual increase in passive
     and active assitive (AAROM) exercises as tolerated (from flexion out into the scapular plane) up to 90° unless otherwise indicated
•    Begin isometrics in all planes as tolerated
•    Soft tissue treatments to scars and surrounding musculature, scapular mobilizations
•    General conditioning as tolerated (include trunk flexion & extension exercises)


2 - 4 weeks:

•    Passive and AAROM flexion out to scaption (plane of the scapula) as tolerated -
     Isotonic wrist, forearm, and scapular exercises
•    Theraband resisted pull-downs from the front and the scapular plane; elbow flexion
     with high reps and low resistance; submaximal isometrics (as dictated by pain);
     active scapular elevation, depression, and retraction exercises; light weight bearing exs.


4 - 6 weeks:

•    Resting pain should be notably diminishing - Continue with passive and AAROM
     exercises (cane exercises, wall walking, table slide) in flexion out to abduction as
     tolerated; maximal isometrics
•    Active exercises from flexion into the scapular plane against gravity as tolerated
•    No resistance until able to perform 30 reps at limb weight with perfect mechanics
•    Okay to add light resistance internal rotation exercises from 0° to the body only
•    UBE with light to no resistance only
•    Add proprioceptive training exs. (alphabet writing, fine motor skills, work / sport
     specific exs.)


6 - 8 weeks:

•    Continue to increase AROM exercises as tolerated (serratus anterior, upper and
     lower trapezius); add eccentrics into protected ranges - Okay to begin LIGHT
     stretching into external rotation
•    Okay to begin LIGHT glenohumeral joint mobilization
•    Increase proprioceptive training (prone on elbows, quadriped position / "on all four's"
     for rhythmic stabilization)
•    UBE with increasing resistance
•    Okay to begin jogging, road cycling, and standing arm resistance exercises in the
     pool


8 - 12 weeks:

•    Emphasis on regaining strength and endurance - Light PNF patterns (proprioceptive
     neuromuscular facilitation)
•    AROM exercises to include internal rotation and external rotation as motion allows,
     lateral raises and supraspinatus isolation, rower with a high seat, decline bench
     press, military press in front of body
•    Running, road or mountain biking, no activities with forceful, ballistic arm movement


3 - 6 months:

•    Aggressive stretching; begin strenuous resistive exercises - Add light throwing
     exercises with attention to proper mechanics


6 months:

•    Increasing throwing program with focus on return to throwing sports as mechanics,
     conditioning, and strength allow