General
Considerations: -
This protocol is a guideline only; actual progression will be based on clinical
presentation.
- Early passive range of motion of the glenohumeral joint to
prevent capsular adhesions is essential. *This
early ROM is done in a manner that shortens the involved the muscle: i.e.,
for supraspinatus avoid adduction past midline and external rotation. -
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 EXCESSIVE reaching and external/internal rotation
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 4 weeks post-op. Sling wear during sleep is optional depending
on comfort.
- Maintain good upright shoulder girdle posture at all times and
especially during sling use.
- M.D. follow-up visits at Day 1, Day 8-10, Month
1, Month 3 and Year 1 post-op. Weeks
0-2: -
M.D. visit day 1 post-op to change dressing and review home program.
- Suture
removal at day 8-10 post-op.
- Exercises (3x per day): 1) pendulum exercises,
2) squeeze ball, 3) triceps and biceps training with Theraband, 4) pulley passive
flexion and scaption (scapular plane) 0-60 degrees, 5) isometric shoulder abduction,
adduction, extension and flexion with arm at side, 6) scapular pinches every hour,
7) neck stretches for comfort. Weeks
2 - 4:
- M.D. visit at 8-10 days for suture removal and check-up.
- Use of strapping
tape for secondary AC compression and support (optional).
- Soft tissue treatments
for associated shoulder and neck musculature for comfort. 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 90 degrees of shoulder
flexion and abduction. Weeks
8 - 12:
- Seek gentle full shoulder ROM in all planes-- especially with flexion,
abduction, external rotation and internal rotation.
- Increase mobilizations
of soft tissue as well as glenohumeral and scapulothoracic joints for ROM.
- Exercises: wand exercises, ROM shoulder pulleys, scapular training (rows, protractions,
lower trapezius work, etc), PNF.
- No overhead lifting. Weeks
12 and beyond:
- Start a more aggressive rotator cuff program as tolerated.
- Start progressive
resistance exercises with weights as tolerated.
- Continue to seek full shoulder
range of motion in all planes.
- 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 targeted sport. | 
