Bankart repair rehabilitation protocol

• 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./nurse follow­ups Day 2, Day 14, 1 month, 4 months, 6 months and 1 year.
• All active exercises should be carefully monitored to minimize substitution or compensation

Week 1

• ­Nurse visit Day 2 to inspect surgical dressing and review home program.
• ­Ice shoulder every 2 hours for 15­20 min during wake hours for first 2 weeks.

Manual​:­

• effleurage
• soft tissue mobilization to surrounding musculature
• gentle scapula glides.

Exercise:

­​ Home program to consist of:

• ­Elbow flexion / extension
• wrist and forearm strengthening
• cervical stretches
• postural education and exercises.

*It is important to come out of the sling frequently to bend and straighten elbow for 10­15 repetitions each time tominimize arm and hand swelling.
­Stationary bike, stair machine, and Versa Climber without putting weight on arms.

Goals:

• Decrease pain and edema.
• Initiate passive range of motion to shoulder per restrictions (anterior­ no ER/Ext, posterior­no IR).
• Passive range of motion < 50 degrees flexion/scaption.
• Full elbow range of motion.

Weeks 2-4

Manual:​

• effleurage
• soft tissue mobilization to surrounding musculature
• gentle scapula glides.
• Pain control​​(i.e. cryotherapy, massage, and electric stimulation).

Goals:

• Decrease pain and edema.
• Passive range of motion < 90 degrees flexion/scaption.

Weeks 4 - 6

MD appointment at 4 weeks, discharge sling if approved by MD.

Manual:

Soft tissue mobilization to surrounding musculature, initiate scar mobilization to surgical incisions ifcompletely closed.

Exercise:

Passive and active assisted flexion out to the scapular plane as tolerated (cane exercises, wall walking,table slide).

• Progress to active exercises from flexion into the scapular plane against gravity as tolerated
  *No resistance until able to perform 30 reps with perfect mechanics.
• Isotonic wrist, forearm, and scapular exercises.
• Theraband resisted pulldowns from the front and the scapular plane; elbow flexion; submaximal isometrics (as dictated by pain); active scapular elevation, depression, and retraction exercises; light weight bearing
• Upper body ergometer with light to no resistance only.
• Add proprioceptive training (alphabet writing, fine motor skills, work / sport specific).

Goals:

• Out of sling; minimal resting pain.
• Initiate active range of motion flexion/scaption.

Weeks 6 - 8

Manual:

Continue with soft tissue mobilization, range of motion.

Exercise:

• Continue to increase active range of motion 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.
• Okay to add light resistance internal rotation exercises from 0 degrees to the body only
• Increase proprioceptive training (prone on elbows, quadruped position / "on all four's"for rhythmic stabilization).
• Upper body ergometer (UBE) with increasing resistance.

Goals:

• Range of motion greater than 80% of normal, initiate tolerance to hand behind head/back exercises.
• Initiate jogging, road cycling, and standing arm resistance exercises in the pool.

Weeks 8 - 12

• Emphasis on regaining strength and endurance.
• Light proprioceptive neuromuscular facilitation (PNF) patterns.
• active range of motion 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:

MD appointment at 12 weeks.

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

6 Months:

• Increase throwing program/sport-specific program. Focus on return to sports as mechanics, conditioning, and strength allow.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.