● No sudden jerking motions. Early Phase II ● Continue with PROM and AAROM.
Precautions ● Sling should be worn continuously for three to four weeks. ● While the patient is supine, a small pillow or towel roll should be placed behind the elbow to avoid shoulder hyperexten- sion, anterior capsule stretch, and subscapularis stretch. ● Avoid shoulder AROM. ● No lifting of objects. ● No excessive shoulder motion behind back, especially into in- ternal rotation (IR). ● No excessive stretching or sudden movements, particularly external rotation (ER). ● No supporting of body weight by hand on involved side. ● Keep incision clean and dry; no soaking for two weeks. ● Gentle ER in scapular plane to available PROM, as document- ed in operative note, usually around 30 degrees. Do not pro- duce undue stress on the anterior joint capsule, particularly with shoulder in extension. ● Passive IR to chest. ● Active distal extremity exercise—elbow, wrist, and hand. ● Pendulum exercises. ● Frequent cryotherapy for pain, swelling, and inflammation management. ● Patient education regarding proper positioning and joint pro- tection techniques. Early Phase I (at home) ● Continue previous exercises. ● Begin scapula musculature isometrics and sets, primarily re- traction. ● Continue active elbow ROM. ● Continue cryotherapy as much as able for pain and inflamma- tion management. Late Phase I ● Continue previous exercises. ● Continue to progress PROM as motion allows. ● Begin assisted flexion, abduction, ER, and IR in the scapular plane. ● Progress active distal extremity exercise to strengthening as appropriate. Criteria for progression to Phase II ● Tolerates PROM program. ● No driving for three weeks. Postsurgery day 1 (in hospital) ● Passive forward flexion in supine to tolerance. ● Achieves at least 90 degrees PROM flexion. ● Achieves at least 90 degrees PROM abduction. ● Achieves at least 45 degrees PROM ER in plane of scapula. ● Achieves at least 70 degrees PROM IR in plane of scapula measured at 30 degrees abduction. PHASE II: EARLY STRENGTHENING PHASE (Not to begin before four to six weeks postsurgery to allow for appropriate soft tissue healing.) Goals ● Restore full PROM. ● Gradually restore AROM. ● Control pain and inflammation. ● Allow continuing healing of soft tissue. ● Do not overstress healing tissue. ● Re-establish dynamic shoulder stability. Precautions ● Sling should be used only for sleeping and removed gradually over the course of the next two weeks for periods throughout the day. ● While the patient is supine, use a small pillow behind the el- bow to avoid shoulder hyperextension and anterior capsule stretch. ● In the presence of poor shoulder mechanics, avoid repetitive shoulder AROM and activity against gravity in standing. ● No heavy lifting of objects—no heavier than a coffee cup. ● No supporting of body weight by hand on the involved side.
● Begin active flexion, IR, ER, and abduction pain-free ROM. ● AAROM pulleys (flexion and abduction) as long as greater than 90 degrees PROM. ● Begin shoulder submaximal pain-free shoulder isometrics in neutral. ● Scapular strengthening exercises as appropriate. ● Begin assisted horizontal adduction. ● Progress distal extremity exercises with light resistance as ap- propriate. ● Gentle glenohumeral and scapulothoracic joint mobilizations as indicated. ● Initiate glenohumeral and scapulothoracic rhythmic stabiliza- tion. ● Continue use of cryotherapy for pain and inflammation. Late Phase II ● Progress scapular strengthening exercises. Criteria for progression to Phase III ● Tolerates PROM, AAROM, and isometric program. ● Achieves at least 140 degrees PROM flexion. ● Achieves at least 120 degrees PROM abduction. ● Achieves at least 60 degrees ER in plane of scapula. ● Achieves at least 70 degrees IR in plane of scapula measured at 30 degrees of abduction. ● Able to actively elevate shoulder against gravity with good mechanics to 100 degrees. PHASE III: MODERATE STRENGTHENING (Not to begin before six weeks postsurgery to allow for appropri- ate healing and to ensure adequate ROM.) Goals ● Gradual restoration of shoulder strength, power, and endur- ance. ● Optimize neuromuscular control. ● Gradual return to functional activities with involved upper ex- tremity. Precautions ● No heavy lifting of objects—no heavier than 3 kg (6 lb., 9 oz. ● No sudden lifting or pulling activities. ● No sudden jerking motions. Early Phase III ● Progress AROM exercises and activity as appropriate. ● Advance PROM to stretching as appropriate. ● Continue PROM as needed to maintain ROM. ● Initiate assisted shoulder IR behind back stretch. ● Resisted shoulder IR, ER in scapular plane. ● Begin progressive supine active elevation strengthening (an- terior deltoid) with light weights—0.5 kg–1.5 kg (1 lb., 2 oz.–3 lb., 5 oz.)—at variable degrees of elevation. Late Phase III ● Resisted flexion, abduction, and extension (TheraBands/sport cords). ● Continue progressing IR, ER strengthening. ● Progress IR behind back from AAROM to AROM as ROM al- lows. ● Continue to pay attention to avoid stress on the anterior cap - sule. Criteria for Progression to Phase IV ● Tolerates AAROM, AROM, and strengthening. ● Achieves at least 140 degrees AROM flexion supine. ● Achieves at least 120 degrees AROM abduction supine. ● Achieves at least 60 degrees AROM ER in plane of scapula supine. ● Achieves at least 70 degrees AROM IR in plane of scapula supine in 30 degrees of abduction. ● Begin light functional activities. ● Wean from sling completely.
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Book Code: PTCA2624
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