Arthroscopic Anterior Stabilization Rehab



Total Shoulder Arthroplasty/ Humeral Head Replacement

Rehabilitation Protocol

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Goals:

• Pain control

• Edema control

• Protect subscapularis, rotator interval, and/or rotator cuff repairs

• Gradual restoration of motion

• Return to effective use of limb for ADLs

• Restore shoulder strength and function

Phase I (0-4 weeks postop)

Sling immobilization except for washing and clothing changes x 4-6 weeks

Exercises 5-6 times/day for 10-15 minutes each session

▪ Codmans/Pendulum exercises using ‘helper hand’ for support

▪ Wrist, Hand AROM

▪ Elbow AROM (***wait 2-3 weeks if biceps tenotomy/tenodesis)

▪ Gripping exercises

▪ Shoulder shrugs

Limits:

• FF-AAROM (supine)-limited to 120o

▪ ER to 10o only

▪ IR to chest wall

▪ Sub-maximal, pain-free deltoid, trapezius, rhomboid isometrics in neutral

ADLs with hand, wrist, elbow

Modalities as needed

Phase II (4-6 weeks)

D/C sling in general

Continue sling whenever out of home in public to protect repairs

Continue FF-AAROM (wand/pulleys)

ER - AAROM to 30º only

FF – begin supine AROM

Manual scapular stabilization exercises

Begin pain-free ER isometrics

ADLs as able hand, wrist, elbow, shoulder except lifting/carrying

Modalities as needed

Phase III (6-8 weeks)

D/C sling

Use of the limb for ADLs as tolerated except no lifting/carrying

6 weeks - begin Biceps/Triceps strengthening

Progress scapular strengthening in protective arcs

Begin limited isotonic IR/ER strengthening in modified neutral

Begin seated active FF in plane of scapula

Begin AROM for ER

Continue to increase FF AROM/PROM/AAROM

Phase IV (8-10 weeks)

Continue scapular strengthening

Advance isotonic strengthening for deltoid, trapezius, biceps, triceps and latissimus as tolerated

Begin progressive resistive exercises of deltoid and rotator cuff

Begin general flexibility exercises at 10 weeks

Phase V (10-16 weeks)

Continue to restore shoulder flexibility

Continue full upper extremity strengthening

Functional training

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