- 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