Kevin B. Freedman, M.D. Sports Medicine 27 South Bryn Mawr Ave Bryn Mawr, PA 19010-34 70 Phone: (610) 527-272 7 Fax: (610) 527-1588 ARTHROSCOPIC ANTERIOR SHOULDER STABILIZATION REHABILITATION PROTOCOL RANGE OF IMMOBILIZER THERAPEUTIC MOTION* EXERCISE PHASE I Ac ti ve/ Ac ti ve- As sis ti ve: Worn at al l ti m es e xc e pt El bo w/ wr is t/ han d ROM, gr ip 0-4 weeks str etc h to 20 o f for hygi ene and th erap eu ti c str en gth en i ng, isometr ic in sli ng, external rotation, and exercise external/internal rotation exercises 90 of forward fl exion - wi th elbow at side intern al rotation to stomach Abduction to 45 degrees No cross-body adduction PHASE II Increase forward flex ion to None Advance i sometri cs in phase I to use 4 - 8 weeks 140/40 ER at side/ 60 of a theraband, continue with elbow/abducti on/ IR behi nd back to wrist/hand ROM and grip strengthening, waist begin prone extensions, and scapular stabilizing exercises, gentle joint mobs Modalities as needed PHASE III Progress to full acti ve None Advance theraband ex ercises to 8 - 12 weeks motion wi thout discomfort use of weights, continue with and Gentle passive stretching progress ex ercises i n phase II at end ranges Include RTC, deltoid, and scapular stabilizers PHASE IV Full without di scomfort None Advance exerci ses in phase III, begin 12 weeks - functional progression to work/sport, 6 months** return to previous activity level* begin upper body ergometer, proprioce ption plyometrics *Patient may return to the weight room at 3 months, if appropriate **Patient may return to competitive sports, including contact sports, by 6 months, if approved NOTE: For open stabilization, no internal rotation strengthening for first 6 wks
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PHASE I Active/Active-Assistive: Worn at all times except Elbow/wrist/hand ROM, grip
0-4 weeks stretch to 20 of for hygiene and therapeutic strengthening, isometric in sling,external rotation, and exercise external/internal rotation exercises
90 of forward flexion - with elbow at side
internal rotation to
stomach
Abduction to 45 degrees
No cross-body adduction
PHASE II Increase forward flexion to None Advance isometrics in phase I to use
4 - 8 weeks 140/40 ER at side/ 60 of a theraband, continue with elbow/
abduction/ IR behind back to wrist/hand ROM and grip strengthening,
waist begin prone extensions, and scapular
stabilizing exercises, gentle joint mobs
Modalities as needed
PHASE III Progress to full active None Advance theraband exercises to
8 - 12 weeks motion without discomfort use of weights, continue with and
Gentle passive stretching progress exercises in phase II
at end ranges Include RTC, deltoid, and scapular
stabilizers
PHASE IV Full without discomfort None Advance exercises in phase III, begin
12 weeks - functional progression to work/sport,
6 months** return to previous activity level*
begin upper body ergometer, proprioception
plyometrics
*Patient may return to the weight room at 3 months, if appropriate
**Patient may return to competitive sports, including contact sports, by 6 months, if approved
NOTE: For open stabilization, no internal rotation strengthening for first 6 wks
PHASE I Active/Active-Assistive: Worn at all times except Elbow/wrist/hand ROM, grip
0-4 weeks stretch to 40 of for hygiene and therapeutic strengthening, isometric in sling,external rotation, and exercise external/internal rotation exercises
120 of forward flexion - with elbow at side
internal rotation to No resisted forward flexion or biceps
stomach until 6 weeks post-op
Abduction to 45 degrees
No cross-body adduction
PHASE II Increase forward flexion to None Advance isometrics in phase I to use
4 - 8 weeks 140/60 ER at side/ 60 of a theraband, continue with elbow/
abduction/ IR behind back to wrist/hand ROM and grip strengthening,
waist begin prone extensions, and scapular
stabilizing exercises, gentle joint mobs
Modalities as needed
PHASE III Progress to full active None Advance theraband exercises to
8 - 12 weeks motion without discomfort use of weights, continue with and
Gentle passive stretching progress exercises in phase II
at end ranges Include RTC, deltoid, and scapular
stabilizers
PHASE IV Full without discomfort None Advance exercises in phase III, begin
12 weeks - functional progression to work/sport,
6 months** return to previous activity level*
begin upper body ergometer, proprioception
plyometrics
Return to throwing at 4 1/2 months
Throw from pitcher's mound at 6 months
*Patient may return to the weight room at 3 months, if appropriate
**Patient may return to competitive sports, including contact sports, by 6 months, if approved