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Knee & Shoulder Doctor

Arthroscopic Anterior Shoulder Stabilization

(Capsular plication and/or Bankart repair)

This protocol has been modified and is being used with permission from the BWH Sports and Shoulder Service.

The purpose of this protocol is to provide the physicians, therapists, and other care providers with a guideline of the post-operative rehabilitation course.

 

Phase I (Weeks 1-3)

Immediate Post Surgical Phase

Goals

  • Protect the surgical repair
  • Diminish pain and inflammation
  • Enhance scapular function


Precautions

  • Remain in sling, only removing for showering and elbow/wrist ROM
  • Patient education regarding avoidance of abduction / external rotation activity to avoid anterior inferior capsule stress
  • No Passive Range of Motion (PROM)/Active Range of Motion (AROM) of shoulder
  • No lifting of objects with operative shoulder
  • Keep incisions clean and dry


Weeks 1-3

  • Sling at all times except where indicated above
  • PROM/AROM elbow, wrist and hand only
  • Normalize scapular position, mobility, and stability
  • Ball squeezes
  • Sleep with sling supporting operative shoulder
  • Shower with arm held at your side
  • Cryotherapy for pain and inflammation
  • Patient education: posture, joint protection, positioning, hygiene, etc.
  • Begin isometrics week 3

 

Phase II (Weeks 4 and 5)

Protection Phase/PROM

Goals

  • Gradually restore PROM of shoulder, external rotation limits as below
  • Do not overstress healing tissue


Precautions

  • Follow surgeon’s specific PROM restrictions- primarily for external rotation
  • No shoulder AROM or lifting


Weeks 4-5

  • Continue use of sling
  • PROM (gentle), unless otherwise noted by surgeon
  • Full flexion and elevation in the plane of the scapula
  • Full Internal rotation
  • External rotation to 30 degrees at 20 degrees abduction, to 30 degrees at 90 degrees abduction
  • Pendulums
  • Sub maximal pain free rotator cuff isometrics in neutral
  • Continue cryotherapy as needed
  • Continue all precautions and joint protection

 

Phase III (Weeks 6 and 7)

Intermediate phase/AROM

Goals

  • Continue to gradually increase external rotation PROM Full AROM
  • Independence with ADL’s
  • Enhance strength and endurance


Precautions

  • Wean from Sling
  • No aggressive ROM / stretching
  • No lifting with affected arm
  • No strengthening activities that place a large amount of stress across the anterior aspect of the shoulder in an abducted position with external rotation (i.e. no pushups, pectoralis flys, etc.)


Weeks 6 and 7

  • PROM (gentle), unless otherwise noted by surgeon
  • External rotation to 30-50 degrees at 20 degrees abduction, to 45 degrees at 90 degrees abduction
  • Begin AROM of shoulder
  • Progress to full AROM in gravity resisted positions
  • Begin implementing more aggressive posterior capsular stretching
  • Cross arm stretch
  • Side lying internal rotation stretch
  • Posterior/inferior gleno-humeral joint mobilization
  • Enhance pectoralis minor length
  • Scapular retractor strengthening
  • Begin gentle isotonic and rhythmic stabilization techniques for rotator cuff musculature strengthening (open and closed chain)
  • Continue cryotherapy as necessary

 

Phase IV (Weeks 8-12)

Strengthening Phase

Goals

  • Continue to increase external rotation PROM gradually
  • Maintain full non-painful AROM
  • Normalize muscular strength, stability and endurance
  • Gradually progressed activities with ultimate return to full functional activities


Precautions

  • Do not stress the anterior capsule with aggressive overhead strengthening
  • Avoid contact sports/activities


Weeks 8-10

  • Continue stretching and PROM
  • External rotation to 65 degrees at 20 degrees abduction, to 75 degrees at 90 degrees abduction, unless otherwise noted by surgeon.
  • Progress above strengthening program


Weeks 10-12

  • Continue stretching and PROM
  • All planes to tolerance.
  • Continue strengthening progression program

 

Phase V ( Weeks 12-20)

Return to activity phase

Goals

  • Gradual return to strenuous work activities
  • Gradual return to recreational activities
  • Gradual return to sports activities


Precautions

  • Do not begin throwing, or overhead athletic moves until 4 months post-op
  • Weight lifting:
    • Avoid wide grip bench press
    • No military press or lat pulls behind the head. Be sure to “always see your elbows”


Weeks 12-16

  • Continue progressing stretching and strengthening program
  • Can begin golf, tennis (no serves until 4 mo.), etc.
  • Can begin generalized upper extremity weight lifting with low weight, and high repetitions, being sure to follow weight lifting precautions as above.


Weeks 16-20

  • May initiate interval sports program if appropriate


Criteria to return to sports and recreational activities:

  • Surgeon clearance
  • Pain free shoulder function without signs of instability
  • Restoration of adequate ROM for desired activity
  • Full strength as compared to the non operative shoulder (tested via hand held dynamometry)

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