PHASE I: Protected ROM (Starting at 4 weeks after injury)
- Sling should be in place when not performing exercises.
- May start active scapular mobility exercises (scapular retraction, elevation in sitting or standing) – Must keep the shoulder musculature relaxed.
- Immediate elbow, forearm and hand range of motion out of sling
- Pendulum exercises
- NO Abduction or IR
- Passive forward flexion (130 degrees), in front of the plane of the scapula as pain allows supine well arm, table slides, or table walk back motion all allowed
- Passive external rotation (30 degrees) with the arm supported in the plane of the scapula: may be supine with cane assistance, seated and supported on arm rest with motion performed by well arm; or propped on counter top and step around
- No lifting anything heavier than a coffee cup (less than 2 lbs)
PHASE II: Progressive ROM (6 to 12 weeks)
- May gradually wean from sling.
- Lifting restriction of 5 pounds should be reinforced with patient.
- Restore full passive motion of the glenohumeral joint first, then progress to active assisted, then active motion through the full range – includes pulleys, wand and supine gravity assisted exercises. Emphasize all motions including IR behind the back at 10-12 weeks.
- Isolate and strengthen scapular stabilizers.
- Progress PROM and terminal capsular stretching of the shoulder as needed.
- Avoid AROM in positions of subacromial impingement.
- May start gentle rotator cuff strengthening at 10 weeks
PHASE III: (> 12 weeks)
- Discontinue formal lifting restrictions.
- Advance rotator cuff and shoulder strengthening (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.