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Rehabilitation Protocol

PHASE I: Protected ROM (6 weeks)

  • 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.
  • 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
  • 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 discontinue sling.
  • Lifting restriction of 5 pounds should be reinforced with patient.
  • Start AAROM and AROM – 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.
  • American Academy of Orthopaedic Surgeons
American Shoulder and Elbow Surgeons
  • New England Shoulder and Elbow Society
  • Boston Sports & Shoulder Center
  • Tufts University