Phase I: Protect repair (0 to 6 weeks)
- May remove dressing and shower postop day #3.
- Sutures are all underneath the skin and will dissolve on their own.
- Ice or cold flow systems encouraged for the first week at a minimum: should be used 3-4 times per day.
- Sling should be in place when not performing exercises.
- Initiate exercise program 3 times per day:
- Immediate elbow, forearm and hand range of motion out of sling
- Pendulum exercises
- Passive and active assistive ER at the side to 30, flexion to 130, true glenohumeral scapular plane abduction 90
- May start active scapular mobility exercises at 3 to 4 weeks – Must keep the shoulder musculature relaxed.
- Isometrics starting 4 weeks
- Avoid range of motion into abduction, ER >30 degrees or active IR
Phase II: Progress ROM & Protect Repair (6 to 12 weeks)
- May discontinue sling.
- Lifting restriction of 5 pounds with the involved extremity.
- Advance active and passive ROM:
- ER at the side and flexion to tolerance
- Scapular plane elevation to 130
- IR and extension to tolerance
- Initiate gentle rotator cuff strengthening.
- Continue scapular stabilizer strengthening.
- Avoid combined abduction and ER ROM, active or passive.
Phase III: Full function (>3 months)
- Begin combined abduction and ER ROM and capsular mobility.
- Discontinue lifting restrictions.
- Advance rotator cuff and scapular stabilizer strengthening.
- Initiate functional progression to sports specific activities at 4 months.