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 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--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