Rehabilitation is advisable, and should consist of core stability, cuff and general shoulder conditioning exercises.
Day 1 – 4 weeks
- Ice packs may be used for the first 2 weeks in 20 min intervals to assist with pain relief
- Sling for 4 weeks including the back strap – remove for exercises 4 times daily. To be worn in bed at night time
- Teach axillary hygiene
- Hand, wrist and elbow ROM exercises
- Pendular exercises
- Check operation notes for degree of allowed external rotation. Generally 0 deg of external rotation. This to be done gently, and actively – no passive stretching.
- Hand to mouth movements
- Teach postural awareness and scapular setting
- Core stability exercises throughout rehabilitation
5 – 8 weeks
- Wean off sling – still to be worn at night
- Active assisted flexion / forward elevation as comfortable
- Active External rotation to neutral
- Proprioceptive exercises (minimal weight bearing below 90 degrees)
- Commence isometric exercise and theraband work
- Scapula strengthening exercises
8 – 12 Weeks
- Increase ROM – External rotation now beyond neutral, still actively
- Strengthen through range
- Increase proprioception through open & closed chain exercise
- Regain scapula control & normal shoulder control
- Incorporate sports-specific rehabilitation
- No stretching of the capsule – allow the range of motion to return only with active movement, no passive stretching.
3 Months +
- Commencement of graded strengthening program
- Work on obtaining a pain free ROM of 90% of the full ROM
- Minimise GIRD
- Assessment with Closed Chain Upper Extremity Stability Test and Upper-Quater Y Balance Test prior to return to contact sport.
- No passive stretching in ER, or AB/ER
- During strengthening, avoid shoulder presses, unsupported bench press and inclined presses. These strengthening programs can potentially damage the repair.
- Bench presses may be done with the scapula supported on the floor, and military presses may be done with the hand in front of the face.
|Week 6||Active elevation to pre-op level|
|Week 12||Aim for 80% range of external rotation compared to asymptomatic side
Normal movement patterns throughout range
Return to contact sport and heavy work is dependent on each precise situation. This will be discussed at the time of surgery with each patient.
Some general guidelines are:
6 weeks – gentle jogging on hard, flat surfaces. Commence work on a stationary bike trainer.
12 weeks – Commence swimming. Generally with breaststroke, then progressing to freestyle as strength and ROM increase.
6 months – Depending on progress and the degree of engagement in rehabilitation contact sports, heavy overhead lifting, surfing, throwing, basketball, and netball may be recommenced.