General Considerations:

•    DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks
     post-op
•    DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks
•    AVOID REPEATED reaching for the first 6 weeks
•    Ice shoulder 3-5 times (15 minutes each time) per day to control swelling and
     inflammation            
•    An arm sling is used for 3- 4 weeks post-op
•    Maintain good upright shoulder girdle posture at all times and especially during sling
     use
•    Intermittent X-ray to monitor healing as needed
•    M.D. follow-up visits at Day 1, Day 8-10, Month 1, Month 3 and Year 1 post-op


Week 1:

•    M.D. visit day 1 post-op to change dressing and review home program
•    Exercises (3x per day):
       o    pendulum exercises
       o    squeeze ball
       o    triceps with Theraband
       o    isometric rotator cuff external and internal rotations with arm at side
       o    isometric shoulder abduction, adduction, extension and flexion with arm at side
•    Soft-tissue treatments for associated shoulder and neck musculature for comfort
•    Cardiovascular training such as stationary bike throughout rehabilitation period


Weeks 2 - 4:

•    Soft-tissue treatments for associated shoulder and neck musculature for comfort
•    Gentle pulley for shoulder ROM 2x/day
•    Elbow pivots PNF, wrist PNF
•    Isometric scapular PNF, mid-range


Weeks 4 - 8:

•    M.D. visit at Week 4 post-op and will usually be progressed to a more aggressive
     ROM and strength program
•    At Week 4: start mid-range of motion (ROM) rotator cuff external and internal
     rotations active and light resistance exercises (through 75% of ROM as patient's
     symptoms permit) without shoulder elevation and avoiding extreme end ROM
•    Strive for progressive gains to active 90 degrees of shoulder flexion and abduction


Weeks 8 - 12:

•    Seek full shoulder Active ROM in all planes
•    Increase manual mobilizations of soft tissue as well as glenohumeral and
     scapulothoracic joints for ROM
•    No repeated heavy resisted exercises or lifting until 3 months


Weeks 12 and beyond:

•    Start a more aggressive strengthening program as tolerated
•    Increase the intensity of strength and functional training for gradual return to
     activities and sports
•    Return to specific sports is determined by the physical therapist through functional
     testing specific to the injury