Lower Trapezius Tendon Transfer to Greater Tuberosity
PHASE I: Protected ROM (8 weeks)
- Patients may shower immediately over clear plastic, waterproof dressing
- 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.
- Gunslinger brace should be in place when not performing exercises.
- Avoid all active and active assistive exercises until cleared by the surgeon. This includes pulley exercises, wand and supine assisted exercises.
- Initiate exercise program 3 times per day:
- Immediate elbow, forearm and hand range of motion out of sling
PHASE II: Progressive ROM (6 to 12 weeks)
- May discontinue brace at 6 weeks.
- Passive external rotation of the shoulder to tolerance - instruct family member (start at 6 weeks)
- PROM into scapular plane elevation to 120 degrees (start at 6 weeks)
- At 6 weeks, perform overhead reach (see below)
Overhead reach is helping to lift your stiff arm up as high as it will go. To stretch your overhead reach, lie flat on your back, relax, and grasp the wrist of the tight shoulder with your opposite hand. Using the power in your opposite arm, bring the stiff arm up as far as it is comfortable. Start holding it for ten seconds and then work up to where you can hold it for a count of 30. Breathe slowly and deeply while the arm is moved. Repeat this stretch ten times, trying to help the arm up a little higher each time.
- May start active scapular mobility exercises at 6 weeks – Must keep the shoulder musculature relaxed.
- Start AAROM and AROM – includes pulleys, wand and supine gravity assisted exercises at 8 weeks. Emphasize all motions except IR behind the back and cross-body adduction until 3 months.
- Isolate and strengthen scapular stabilizers.
- Progress PROM and capsular stretching of the shoulder as needed – elevation and external rotation as tolerated
- Avoid resisted training or strengthening. Avoid AROM in positions of subacromial impingement.
PHASE III: (> 12 weeks)
- Lifting restriction of 5 pounds should be reinforced with patient.
- Start progressive rotator cuff and shoulder strengthening at 3 months –isometrics initially
- Initiate isotonic strengthening at 4-5 months (Theraband, dumbbells, Hughston’s exercises, etc). Include home cuff strengthening program. Continue to emphasize scapular stabilizers.
- Equate active and passive range of motion. Encourage scapulohumeral mechanics during active shoulder motion.
- Simulate work/recreational activities as rotator cuff strength and endurance improve.