Arthroscopic Anterior Shoulder Stabilization
Arthroscopic Anterior Shoulder Stabilization (Capsular plication and/or Bankart repair):
The purpose of this protocol is to provide the physicians, therapists, and other care providers with a guideline of the post-operative rehabilitation course.
Phase I – Immediate Post Surgical Phase (Week 1-3):
Goals:
• Protect the surgical repair
• Diminish pain and inflammation
• Enhance scapular function
Precautions:
• Remain in sling, only removing for showering and elbow/wrist ROM
• Patient education regarding avoidance of abduction / external rotation activity to avoid anterior inferior capsule stress
• No Passive Range of Motion (PROM)/Active Range of Motion (AROM) of shoulder
• No lifting of objects with operative shoulder
• Keep incisions clean and dry
Weeks 1-3:
• Sling at all times except where indicated above
• PROM/AROM elbow, wrist and hand only
• Normalize scapular position, mobility, and stability
• Ball squeezes
• Sleep with sling supporting operative shoulder
• Shower with arm held at your side
• Cryotherapy for pain and inflammation
• Patient education: posture, joint protection, positioning, hygiene, etc.
• Begin isometrics week 3
Phase II – Protection Phase/PROM (Weeks 4 and 5):
Goals:
• Gradually restore PROM of shoulder, external rotation limits as below
• Do not overstress healing tissue
Precautions:
• Follow surgeon’s specific PROM restrictions- primarily for external rotation
• No shoulder AROM or lifting
Weeks 4-5
• Continue use of sling
• PROM (gentle), unless otherwise noted by surgeon
o Full flexion and elevation in the plane of the scapula
o Full Internal rotation
o External rotation to 30 degrees at 20 degrees abduction, to 30 degrees at 90 degrees abduction
• Pendulums
• Sub maximal pain free rotator cuff isometrics in neutral
• Continue cryotherapy as needed
• Continue all precautions and joint protection
Phase III – Intermediate phase/AROM (Weeks 6 and 7):
Goals:
• Continue to gradually increase external rotation PROM Full AROM
• Independence with ADL’s
• Enhance strength and endurance
Precautions:
• Wean from Sling
• No aggressive ROM / stretching
• No lifting with affected arm
• No strengthening activities that place a large amount of stress across the anterior aspect of the shoulder in an abducted position with external rotation (i.e. no pushups, pectoralis flys, etc.)
Weeks 6 and 7
• PROM (gentle), unless otherwise noted by surgeon
o External rotation to 30-50 degrees at 20 degrees abduction, to 45 degrees at 90 degrees abduction
• Begin AROM of shoulder
o Progress to full AROM in gravity resisted positions
• Begin implementing more aggressive posterior capsular stretching
o Cross arm stretch
o Side lying internal rotation stretch
o Posterior/inferior gleno-humeral joint mobilization
• Enhance pectoralis minor length
• Scapular retractor strengthening
• Begin gentle isotonic and rhythmic stabilization techniques for rotator cuff musculature strengthening (open and closed chain)
• Continue cryotherapy as necessary
Phase IV – Strengthening Phase (Week 8 – Week 12)
Goals:
• Continue to increase external rotation PROM gradually
• Maintain full non-painful AROM
• Normalize muscular strength, stability and endurance
• Gradually progressed activities with ultimate return to full functional activities
Precautions:
• Do not stress the anterior capsule with aggressive overhead strengthening
• Avoid contact sports/activities
Weeks 8-10
• Continue stretching and PROM
o External rotation to 65 degrees at 20 degrees abduction, to 75 degrees at 90 degrees abduction, unless otherwise noted by surgeon.
• Progress above strengthening program
Weeks 10-12
Continue stretching and PROM
o All planes to tolerance.
• Continue strengthening progression program
Phase V – Return to activity phase (Week 12 – Week 20)
Goals:
• Gradual return to strenuous work activities
• Gradual return to recreational activities
• Gradual return to sports activities
Precautions:
• Do not begin throwing, or overhead athletic moves until 4 months post-op
• Weight lifting:
• Avoid wide grip bench press
• No military press or lat pulls behind the head. Be sure to “always see your elbows”
Weeks 12-16
• Continue progressing stretching and strengthening program
• Can begin golf, tennis (no serves until 4 mo.), etc.
• Can begin generalized upper extremity weight lifting with low weight, and high repetitions, being sure to follow weight lifting precautions as above.
Weeks 16-20
• May initiate interval sports program if appropriate
Criteria to return to sports and recreational activities:
• Surgeon clearance
• Pain free shoulder function without signs of instability
• Restoration of adequate ROM for desired activity
• Full strength as compared to the non operative shoulder (tested via hand held dynamometry)
Protocol modified and used with permission from BWH Sports/Shoulder Service.
