ARTHROSCOPIC SLAP REPAIR

*6-8 total visits over 12 weeks

Stage I (0-4 weeks)

A. Shoulder sling: wear for 4 weeks. May remove for dressing, hygiene and tabletop use ofhand/wrist/elbow.

B. Exercises: Pendulum (2-3x/day), Elbow ROM.

Stage II (4-12 weeks)

A. Start physical therapy at 4 weeks post-op.

B. P/AAROM/AROM program: 1-2x/day until full active and passive ROM.

GOAL: Full AROM at 10 weeks post-op.

C. Strengthening: Isotonic exercises per shoulder exercise sheet.

1. Perform once per day, 4 days per week.

2. All exercises pain-free ROM only!

3. Utilize free weights only except theraband with internal rotation by side of body.

4. High repetitions, low resistance.

a. Repetitions: 20-40 before adding/progressing weights.

b. Start against gravity only progress as tolerated to:

- 2 oz (butter knife)

- 4 oz (tuna can)

- 8 oz (soup can)

- 1# weight

- 2# weight, etc.

c. GOAL: Thrower/Pitcher: 5-8% of body weight times 50 reps.

General Rehab Candidate: 2-3% of body weight times 50 reps.

Stage I II (3-6 months)

A. Overhead lifting/traction (pull-ups) as tolerated at 4 months.

B. Throwing Activity: start 4 months post-op. Follow functional progression per IAMprotocol. Full throwing status at 6-8 months.

C. Contact Activities: can start at 4 months post-op.

This protocol provides you with general guidelines for the rehabilitation of the Arthroscopic SlapRepair patient. Specific changes in the program will be made by the physician as appropriate foran individual patient. If you have any questions regarding the progress of the patient, thephysician should be contacted.

ARTHROSCOPIC SUBACROMIAL DECOMPRESSION

(With or without distal clavicle resection)

Stage I (0-4 weeks)

4-5 visits in 4 weeks

Patient can wear sling 1-2 days.

A. AAROM (wand exercises)/AROM program see wand exercise sheet.

B. Rotator cuff free weight exercises per shoulder strengthening program 4 days per week

ALL EXERCISES PAIN-FREE ONLY

1. Isotonic exercises 1-8 as tolerated start against gravity without weights

progress as tolerated to:

- 2 oz (butter knife)

- 4 oz (tuna can)

- 8 oz (soup can)

- 1# weight

- 2# weight, etc.

2. Repetitions 25 reps before adding/progressing weights.

C. Scapular stabilization exercises #1-7.

D. Ice following exercises

E. Scar mobilization

*GOAL: Full AROM at 4 weeks with no pain. No inflammation.

Stage II (5+ weeks)

2-3 visits over 2 months

A. Progress on rotator cuff free weight program independently 4 days per week.

B. Scapular stabilization exercise #8.

C. GOAL: 2-3% ideal body weight for 25 reps and maximum weight by 3 months post-op

*GOAL: Return to sports or work at 1-3 months post-op without restrictions.

Return to work per M.D. with restrictions.

7 days/week for stretching/ice 4 days/week for strengthening

NO INFLAMMATION!

This protocol provides you with general guidelines for the rehabilitation of the ArthroscopicSubacromial Decompression patient. Specific changes in the program will be made by thephysician as appropriate for an individual patient. If you have any questions regarding theprogress of the patient, the physician should be contacted.

BANKART REHABILITATION

(Arthroscopic or Open)

*6-8 total visits over 12 weeks

Stage I (0-3 weeks for open repair)

(0-4 weeks for arthroscopic repair)

A. Shoulder sling placed in O.R. May remove sling for dressing and hygiene.

Wear shoulder sling for 3 weeks for open repair; 4 weeks for arthroscopic repair. Mayremove sling for tabletop activities within pain tolerance such as eating, brushing teeth,writing, and occasional keyboard use. May also remove for exercises, showering, anddressing.

B. Exercises ROM elbow

tennis ball for grip

co-contracture of biceps/triceps at 0, 30, 60, 90, 120

Pendulum exercises

Stage II (4-12 weeks)

A. Start P.T. at 4 weeks post-op

1 visit per week for isometric exercises and wand program (see exercise sheet)

Scapular stabilization exercise #1.

At 6 weeks post-op.

PT 1 time every 2 weeks until independent with home program.

B. ROM

1. AROM/PROM for all shoulder motions.

Except NO ER past 20 until 6 weeks post-op. Full ER by 12 weeks.

Progress as tolerated.

2. IR/ER exercises at 5 weeks post-op against gravity no isometrics.

3. Home program: Overhead pulleys if needed

Wand exercises

A. Strengthening Exercises

1. Isometric Exercises start at 4 weeks post-op

per isometric exercise sheet no IR or adduction until 6weeks post-op

pain-free only

Reps: 7-10 x 10 seconds each progress to 30 x 10 secondseach

2. Isotonic Exercises start at 6 weeks post-op per isotonic exercise sheet (#1-8)

Start against gravity only progress as tolerated to:

4 oz (butter knife)

8 oz (tuna can)

1# weight (soup can)

2# weight, etc.

GOAL: Thrower/pitcher: 5-8% of body weight x 50 reps.

General Rehab Candidate: 1-3% of body weight x 25 reps.

3. Scapular stabilization exercises #2-8 as tolerated.

Stage I II (3-6 months)

A. Overhead lifting/traction activities as tolerated at 4 months.

B. Calisthenic Exercises

1. No pull-ups until 4 months post-op.

2. Throwing Activity: start 4 months post-op. Follow functional progression perIAM program. Progress as tolerated.

3. Return to sport at 4 months post-op if PT goals have been met.

4. No Dips until 4 months.

5. Full return to throwing at 6-8 months.

This protocol provides you with general guidelines for the rehabilitation of the Bankart Shoulderpatient. Specific changes in the program will be made by the physician as appropriate for anindividual patient. If you have any questions regarding the progress of the patient, the physicianshould be contacted.

MASSIVE OPERATIVE ROTOATOR CUFF REPAIR

With or Without Clavicle Resection

(Arthroscopic or Open)

Stage I (0-6 weeks) 6 visits

A. Patient to wear sling or abduction pillow continuously for 4 weeks. The sling may be offfor exercises, showering, and dressing. OK to do tabletop activities within pain tolerance(eat, brush teeth, write and occasional keyboard).

If in abductor brace or pillow, only PROM/AAROM above level of brace or pillow. Theabductor brace is used only for patients with a problem with the deltoid; therefore, protectanterior deltoid.

B. AAROM only to limits determined in operating room. If no limits on prescription,assume patient able to do full ROM.

1. Pendulum (Codman) exercises.

2. See wand exercise sheet for AAROM exercises.

3. Strongly suggest home pulley use.

4. Ice following treatment and home exercises.

5. Scapular stabilization exercise #1. (scapular retraction)

*GOAL: Full PROM to pre-set limits or if no limits, to symmetric ROM.

*PRECAUTIONS: Protect anterior deltoid and rotator cuff.

*VISITS: 1 time per week with a maximum of 6 visits over 6 weeks.

Stage I I (6-10 weeks)

A. AROM, no weight, painfree arc only, per rotator cuff exercise sheet #1-8.

*GOAL: AROM to 75% of predetermined limits.

*PRECAUTIONS: Do not increase inflammation.

*VISITS: 1 time per week (max) or 1 time every other week.

B. Scapular stabilization exercises #2-5.

Stage I II (10 weeks-5 months)

A. AROM for all exercises per exercise sheet exercises 1-8 (impingement protocol)

1. Use 2 oz to 1 lb weights

2. Patient should experience only minimal pain with exercises or occurring later inday.

B. Scapular stabilization exercises #6, 7.

*GOAL: Full AROM by week 12

*PRECAUTION: Do not increase inflammation or overwork cuff.

4 oz weight limit until week 8, then progress as tolerated

*VISITS: 2 maximum over these 6 weeks

Emphasis is on home program.

Stage I V (5-6 months)

A. Progress on rotator cuff exercises with no weight limit. Emphasis is on home program.

B. Scapular stabilization exercise #8.

*GOALS: Return to work and sports without limits 4-6 months post-op.

Full AROM to pre-set limits.

Home Program: 7 days/week for stretching/ice

4 days/week for strengthening

*VISITS: 1 time every 2 weeks (max) only if patient is havingsignificant difficulty.

This protocol provides you with general guidelines for the rehabilitation of the rehabilitation ofthe rotator cuff repair shoulder patients. Specific changes in the program will be made by thephysician as appropriate for an individual patient. If you have any questions regarding theprogress of the patient, the physician should be contacted.

CONSERVATIVE MULTI-DIRECTIONAL

CAPSULAR INSTABILITY

*4-6 total visits over 6 weeks.

I. Modalities: Ice following exercise as needed.

II. ROM: 1x/day if passive forward elevation (shoulder flexion) is limited.

A. Pendulum/Codmans

B. Active-assisted shoulder flexion with pulleys or wand except minimal painonly!

I. Strengthening: Perform 1x/day, 4 days/week

A. All exercises pain-free ROM only.

B. High repetitions, low resistance on all PREs.

C. Isotonic exercises per shoulder exercise sheet.

1. Repetitions: 20-40 reps before adding/progressing weights.

2. Start against gravity only progress as tolerated to:

2 oz (butter knife)

4 oz (tuna can)

8 oz (soup can)

1# weight

2# weight, etc.

1. Goals: Athlete/Thrower: 5-8% of body weight x 50 reps.

General Rehab Candidate: 2-3% of body weight x 25 reps.

A. Closed Chain/Scapular Stabilization Exercises: per Scapular StabilizationExercise sheet.

I. General Information

A. Minimal to no pain during or after exercises.

B. Call physician if patient not responding.

C. Emphasize posterior rotator cuff and subscapularis.

POSTERIOR SHOULDER REHABILITATION

*6-10 total visits over 16 weeks

Stage I (0-4 weeks)

A. Post-op external rotation brace with arm at side in neutral rotation. 10 abduction and 5extension.

B. After surgery in O.R., patient is placed into brace and remains in brace for 4-6 weeks

may remove brace for dressing and hygiene, but position of arm must bemaintained. (No writing unless patient uses a clipboard)

A. Exercises ROM elbow

tennis ball for grip

co-contracture of biceps/triceps at 0, 30, 60, 90, 120

isometrics in 0 IR

D. No IR past neutral no reaching into back pocket.

Stage II (4-12 weeks)

A. Start physical therapy 4 weeks post-op

B. ROM

Goal: Full ROM by week 12

1. Active and passive ROM for all shoulder motions, except no IR past 0 until 6weeks post-op unless patient out of brace before then.

Emphasis on ER>IR. Slowly progress as tolerated.

2. Home Program: overhead pulleys if needed

Wand exercises

3. Continue with brace until 4-6 weeks post-op

1. Scapular stabilization exercise #1.

*VISITS: 1-2 times per week for 2 weeks, then 1 time per week oronce every 2 weeks (maximum 6-8 visits total).

A. Strengthening Exercises

1. Isometrics

- start at 4 weeks post-op

per isometric exercise sheet

pain-free only

Reps: 7-10 x 10 seconds each progress to 30 x 10 seconds each

to be performed in

This protocol provides you with general guidelines for the rehabilitation of the PosteriorShoulder Rehabilitation patient. Specific changes in the program will be made by the physicianas appropriate for an individual patient. If you have any questions regarding the progress of thepatient, the physician should be contacted.

CONSESRVATIVE ROTATOR CUFF TEAR PROGRAM

*3-4 visits over 4-6 weeks. (usually 2 or 3 visits).

Emphasis is on A/AAROM and a high repetition, low weight program. Patient should have atleast 80% of full AROM for each exercise before adding 2 oz weight.

I. Modalities

A. Ice following exercises

B. NO phonophoresis/iontophoresis

I. ROM (2 times per day if limited)

A. AAROM in all movements full painfree range as tolerated pulleys if necessary

B. Work on internal rotation (if limited)

C. Wall climbs

I. Strengthening ALL EXERCISES PAINFREE ONLY perform once per day, 4 daysper week

A. Isotonic exercises per shoulder exercise sheet. 1-8 as tolerated.

1. To be performed with free weights only (no theraband), except IR can beperformed with theraband.

a. Repetitions 20-40 reps before adding/progressing weights

b. Start against gravity only progress as tolerated to

4 oz (tuna can)

8 oz (soup can)

1# weight

2# weight, etc.

a. Goals

0. General Rehab Candidate: 1-4% of body weight x 25 reps

1. Progress weight as tolerated painfree

2. Massive Tears: Full AROM without weight

1. If unable to perform exercises against gravity, then instruct patient to dosupine AROM without weight; progressing to using weights supine andAAROM against gravity (wand exercises).

A. Scapular stabilization exercises #1-6 as tolerated.

B. Isometrics within 5 of painful area in all movements if isotonics not tolerated.

IV. General Information

A. Minimal to no pain performing exercises. Fatigue is ok.

B. Call MD if patient not responding to treatment.

This protocol provides you with general guidelines for the rehabilitation of the conservativerotator cuff tear program. Specific changes in the program will be made by the physician asappropriate for an individual patient. If you have any questions regarding the progress of thepatient, the physician should be contacted.

SHOULDER IMPINGEMENT SYNDROME

CONSERVATIVE MANAGEMENT

*4-6 visits over 6 weeks. Emphasis is on a high repetition, low weight program.

I. Modalities

A. Ice following exercises

B. TFM for tendonitis

C. NO phonophoresis/iontophoresis

D. Ultrasound (rarely indicated)

I. ROM (2 times per day) if limited

A. Codmans prior to exercises.

B. AAROM in all movements full ROM if tolerated - ACCEPT minimal painonly!!

C. Work especially on internal rotation in sidelying position.

D. Wall climbs

I. Strengthening ALL EXERCISES PAINFREE ROM ONLY perform once per day,

4 days per week

A. Isotonic exercises per shoulder exercise sheet - 1-8 as tolerated.

1. To be performed with free weights only (NO THERABAND).

Except IR to be performed with theraband if needed.

a. Repetitions 20-50 reps before adding/progressing weights

b. Start against gravity without weight progress as tolerated to

2 oz (butter knife)

4 oz (tuna can)

8 oz (soup can)

1# weight

2# weight, etc.

1. Goals

a. Thrower/Pitcher: 5-8% of body weight x 50 reps

b. General rehab candidate: 2-3% of body weight x 20 reps

c. Progress weight as tolerated

c. B. Isometrics within 5 of painful area in all movements if isotonics nottolerated.

d. C. Scapular stabilization exercises #1-8 as tolerated.

I. General Information

A. Minimal to no pain during or after exercises.

B. Call MD if patient not responding to treatment.

This protocol provides you with general guidelines for the rehabilitation of the shoulderimpingement syndrome patient. Specific changes in the program will be made by the physicianas appropriate for an individual patient. If you have any questions regarding the progress of thepatient, the physician should be contacted.

TOTAL SHOULDER REPLACEMENT

*6-10 visits total over 4 months

Stage I (1-11 days post-op)

Sling to be worn 1-4 weeks depending on subscapularis repair and status of rotator cuff. Thephysician will instruct the patient.

Patient can do tabletop activities including eating, writing and limited computer use.

A. PROM/AAROM follow specific limits to ROM if ordered.

1. Pendulum

2. Pulleys flexion and abduction with neutral rotation (palm down).

3. Passive forward flexion and abduction in supine with neutral rotation.

4. Wand exercises including flexion, supine and stand, ER to neutral, extension,abduction with neutral rotation, IR.

B. Easy Isometric Exercises

IR, ER, extension, abduction, and flexion.

C. Scapular stabilization exercise #1.

Stage II (11-28 days post-op)

A. AROM and Strength

1. Active forward flexion in supine from 45 and higher.

2. Gradual increase of activities from supine to vertical.

3. Isotonic exercises #1, 2, 3, 4, 6 without weight.

Main emphasis on flexion and ER to limit determined in OR.

4. Scapular stabilization exercises #2-5.

Stage III (4-6 weeks)

The protocol is now like impingement protocol.

A. Isotonic exercises per shoulder exercise sheet 1-8 as tolerated.

1. To be performed with free weights only (NO THERABAND) except IR can beperformed with theraband.

2. Repetitions 20-30 before adding/progressing weights.

3. Start against gravity without weight as in Stage II, progress as tolerated to:

- 2 oz (butter knife)

- 4 oz (tuna can)

- 8 oz (soup can)

- 1# weight

- 2# weight, etc.

B. Scapular stabilization exercises #6-7.

Stage IV (7-12 weeks)

A. Return to all functional activities (includes golf).

B. Avoid jamming activities hammering, contact sports.

This protocol provides you with general guidelines for the rehabilitation of the TotalReplacement Shoulder patient. Specific changes in the program will be made by the physician asappropriate for an individual patient. If you have any questions regarding the progress of thepatient, the physician should be contacted.

Arthroscopic SLAP RepairArthroscopic Subacromial DecompressionBANKART RehabilitationMassive Operative Rotator Cuff RepairConservative Multi-Directional Capsular InstabilityPosterior Shoulder RehabilitationConservative Rotator Cuff Tear ProgramShoulder Impingement Syndrome Conservative ManagementTotal Shoulder Replacement