Goals:

• Protect integrity of repair
• Decrease inflammation and pain
• Improve passive range of motion (PROM)

Precautions:

• Maintain arm in abduction sling/brace, remove only for clothing/bathing
• No active range of motion (AROM) of shoulder
• No lifting of objects
• No shoulder motion behind back
• No excessive stretching or sudden movements
• No supporting of any weight No lifting of body weight by hands
• Keep incision clean and dry

Week 0-4 (Phase IA):

• PROM progressing per patient’s tolerance in Flexion and ER
• Pendulum exercises
• Elbow, wrist and hand ROM
• Postural instructions to promote active scapular retraction
• Scapular clock exercises
• Shoulder mobilization – posteriorly
• Ice and pain modalities as indicated

Week 4-6 (Phase IB):

• Continue PROM
• Begin PROM in Abduction per patient tolerance
• Shoulder mobs – posterior and caudal
• Pec minor flexibility
• Begin shoulder IR flexibility
• Begin isotonic scapular retraction /protraction
• Begin manual resistance scapular stabilization
• Begin Sub-max isometrics
• Shoulder flexion
• Shoulder abduction
• Shoulder extension
• Ice and pain modalities as indicated

Criteria for progression to the next phase (II):

• Passive forward flexion to at least 125°
• Passive ER in scapular plane to at least 75°
• Passive IR in scapular plane to at least 75°
• Passive Abduction to at least 90° in the scapular plane

Goals:

• Allow healing of soft tissue
• Minimize stress to healing tissue

Precautions:

• No lifting
• No supporting of body weight by hands and arms
• No sudden jerking motions
• No excessive behind the back movements
• Avoid upper extremity bike or upper extremity ergometer at all times

Week 6-8 (Phase IIA):

• D/C sling per physician
• AAROM per patient tolerance
• Proprioception exercise
• Ball on wall, UE swiss ball mobility –IR/ER

Week 8-10(Phase IIB):

• Begin progression of AROM per patient tolerance
• Avoid Scapular Substitution

Criteria for progression to the next phase (III):

• Full AROM avoiding scapular substitution
• Independent dressing ADLs

Goals:

• Achieve/maintain full ROM
• Gradual restoration of shoulder strength, power, and endurance
• Optimize neuromuscular control
• Gradual return to functional activities

Precautions:

• No heavy lifting of objects (no heavier than 5 lbs.)
• No sudden lifting or pushing activities
• No sudden jerking motions
• No overhead lifting
• Avoid upper extremity bike or upper extremity ergometer at all times

Week 10-12 (Phase IIIA):

• Continue stretching and passive ROM (as needed)
• Dynamic stabilization exercises
• Light theraband/tubing exercises
• Shoulder IR/ER
• Horizontal Abduction / Adduction
• Begin Prone exercise program no weight
• Row
• Shoulder Extension
• Horizontal Abduction – T exercise position
• Lower Trap – Y exercise position
• Begin rhythmic stabilization exercises supine

Week 12-16 (IIIB):

• Progress T-band exercises
• Begin Diagonal Patterns
• Begin Prone exercise program with weight
• Row
• Shoulder Extension
• Horizontal Abduction – T exercise position
• Lower Trap – Y exercise position
• Progress Dumbbell Program with weight
• Scaption
• Diagonal patterns
• Bent row
• Prone Retraction with ER
• Functional eccentric strengthening
• Progress closed chain UE strengthening
• Push up with a plus
• Swiss ball activities
• Trunk and lower-extremity strengthening

Criteria for progression to the next phase (IV):

• Full AROM with no scapular substitution
• Able to tolerate the progression to low-level functional activities
• Return of strength/dynamic shoulder stability
• Adequate strength and dynamic stability for progression to higher demand activities

Goals:

• Maintain full painless active ROM
• Improve muscular strength, power, and endurance
• Gradual return to full functional activities

Week (16-20):

• Continuation of functional UE/LE strengthening and endurance activity
• Stretching program with emphasis on posterior capsule
• Light sports (e.g., golf chipping/putting) if progressing