Maximal isometrics for all cuff, periscapular, and ...



Proximal Biceps TenodesisGeneral Precautions:Overriding tenet is that patient may progress through this protocol as long as they do not experience pain during or immediately after exercising, and they do not experience increasing nighttime pain. Phase 1: (week 0-1)GoalsMaintain / protect the integrity of repairGradually increase AROMDiminish pain and inflammationPrevent muscular inhibitionBecome independent with modified ADLsPrecautionsMaintain sling for comfort. Can remove as tolerated for exercises or ADL’sNo sudden jerking motionsKeep incision clean and dryCriteria for Progression to Phase 2Active forward flexion to fullActive ER to fullActive IR to fullActive abduction to full in the scapular planeDays 1 to 6Sling for comfortPendulum exercisesFinger, wrist, and elbow AROM without weightsBegin scapula musculature isometrics / sets; cervical ROMCryotherapy for pain and inflammationDays 3 to 6Begin pulley exercises in forward flexion and abduction without restrictionsMaintain proper posture, joint protection, positioning and hygieneDays 7 to 28Sling at night and day for comfort onlyPendulum / pulley exercisesBegin AROM to tolerance. No weight restrictions but must avoid rapid acceleration activities and / or loading of bicepsER in scapular planeIR in scapular planeContinue elbow, wrist, and finger AROM / resistedMaximal isometrics for all cuff, periscapular, and shoulder musculatureCryotherapy is needed for pain control and inflammationMay resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin one week postoperativePhase 2: (week 1-6)GoalsAllow healing of soft tissueDo not overstress healing tissueFull AROMDynamic shoulder stabilityGradual restoration of shoulder strength, power, and enduranceOptimize neuromuscular controlGradual return to functional activitiesDecrease pain and inflammationPrecautionsNo sudden jerking motionsCriteria for progression to Phase 3Full AROMWeeks 3-4Discontinue SlingContinue Cryotherapy as neededGradually improve AROMFlexion and elevation in the plane of the scapulaAbduction to fullExternal / Internal rotation to fullExtension to toleranceMay use heat before ROM exercisesIce after ROM exercisesAquatherapy OK for AROM exercisesWeeks 5-6Continue AROM and stretching exercisesContinue rotator cuff isometricsContinue periscapular exercisesGradually improve AROMFlexion and elevation in the plane of the scapula to fullAbduction to fullExternal / Internal rotation to fullExtension to tolerancePhase 3: (week 7-12)GoalsMaintain full non-painful AROMAdvance conditioning exercises for enhanced functional useImprove muscular strength, power and enduranceGradual return to full activitiesWeek 7Continue ROM and self-capsular stretching for ROM maintenanceContinue progression of strengtheningAdvance proprioceptive, neuromuscular activitiesLight sports (golf chipping / wedges, tennis ground strokes) if doing wellContinue strengthening and stretchingContinue stretching if motion is tightInitiate interval sports program (e.g., golf, doubles tennis) if appropriate ................
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