Alaska Native Tribal Health Consortium



Bankart Repair Rehab ProtocolPhase 1: (week 0-6)GoalsMaintain / protect the integrity of repairGradually increase PROMDiminish pain and inflammationPrevent muscular inhibitionBecome independent with modified ADLsPrecautionsMaintain arm in Shoulder Immobilizer, remove only for exerciseNo shoulder AROM, lifting of objects, shoulder motion behind the back, excessive stretching or sudden movements, supporting of any weight, lifting a body weight by handsKeep incision clean and dryCriteria for Progression to Phase 2Passive forward flexion to > 90°Passive ER to 10°Passive IR in scapular plane to > 75° (if uninvolved shoulder PROM > 80°)Passive abduction > 90° in the scapular planeDays 1 to 6Shoulder ImmobilizerPendulum exercisesFinger, wrist, and elbow AROMBegin scapula musculature isometrics / sets; cervical ROMCryotherapy for pain and inflammationDays 3 to 6Begin pulley exercises in forward flexion and abduction < 90°Maintain proper posture, joint protection, positioning and hygieneDays 7 to 28Continue with Shoulder Immobilizer at night and day for comfortPendulum / pulley exercisesBegin PROM to tolerance (done supine; should be pain free)Flexion to 90°ER to 20°IR to body / chestContinue elbow, wrist, and finger AROM / resistedCryotherapy is needed for pain control and inflammationMay resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin three weeks postoperativePhase 2: (week 6-12)GoalsAllow healing of soft tissueDo not overstress healing tissueGradually restore full PROM (weeks 4-5)Decrease pain and inflammationPrecautionsNo liftingNo supporting body weight with hands and armsNo sudden jerking motionsAvoid upper extremity bike and ergometerCriteria for progression to Phase 3Full AROMWeeks 6Discontinue Shoulder Immobilizer at night Between weeks 4-6, use Shoulder Immobilizer for comfort onlyDiscontinue Shoulder Immobilizer at end of week 6Initiate AAROM flexion in supine positionProgressive PROM until approximately full ROM at weeks 4-5.Follow Flexion / ER guidelines.Gentle scapular / glenohumeral joint mobilization to regain full PROM (no anterior glides until 8 weeks post-op)Initiate prone rowing to the neutral arm positionContinue cryotherapy as neededMay use heat before ROM exercisesAquatherapy OK for light AROM exercisesIce after exerciseWeeks 8Continue AROM, AAROM, and stretching exercisesBegin rotator cuff isometrics – No empty can in forward planeContinue periscapular exercisesInitiate AROM exercises (flexion scapular plane, abduction, ER, IR)* Please note: Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercisesAAROM = active assisted range of motionADL = activity of daily livingAROM = active range of motionER = external rotationIR = internal rotationPROM = passive range of motionROM = range of motionPhase 3: (week 10-16)GoalsFull AROM (weeks 10-16)Maintain full PROMDynamic shoulder stabilityGradual restoration of shoulder strength, power, and enduranceOptimize neuromuscular controlGradual return to functional activitiesPrecautionsNo lifting objects >5 pounds, sudden lifting or pushing activities, sudden jerking motions, overhead liftingAvoid upper extremity bike and ergometerCriteria for progression to Phase 4Ability to tolerate progression to the low level functional activitiesDemonstrated return of strength / dynamic shoulder stabilityReestablishment of dynamic shoulder stabilityDemonstrated adequate strength and dynamic stability for progression to more demanding work- and sport-specific activitiesWeek 10Continue stretching and PROM, as neededDynamic stabilization exercisesInitiate strengthening programER and IR with exercise bands / sports cord / tubingER side-lying (lateral decubitus)Lateral raises *Full can in scapular plane *Prone rowingProne horizontal abductionProne extensionElbow flexionElbow extensionWeek 12Continue all exercises listed aboveInitiate light functional activities as permittedFull can in forward plane *Week 14Continue all exercises listed aboveProgress to fundamentals shoulder exercises* Please note: Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercisesPhase 4: (week 16-22)GoalsMaintain full non-painful AROMAdvance conditioning exercises for enhanced functional useImprove muscular strength, power and enduranceGradual return to full activitiesWeek 16Continue ROM and self-capsular stretching for ROM maintenanceContinue progression of strengtheningAdvance proprioceptive, neuromuscular activitiesLight sports (golf chipping / wedges, tennis ground strokes) if doing wellWeek 20Continue strengthening and stretchingContinue stretching if motion is tightInitiate interval sports program (e.g., golf, doubles tennis) if appropriateGeneral GuidelinesWEEKSForward FlexionExternal Rotation0-290o10o2-4110o20o4-6130o30o6-8160o458-12FullFull1)No pull-ups until 6 months post-op2)Throwing activity -?start at 4 to 6 months post-op.? Follow function progression?per SMOG program.? Progress as tolerated.3)Return to non-contact sports at 4 months post-op if?PT goals have been met4)No dips – until 6 months5)Full return to throwing?at 6-8 months ................
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