PHASE I – IMMEDIATE MOTION PHASE (0-2 WEEKS)

GOALS:

• Proper healing of surgical incisions.
• Pain and edema control.
• Prevent effects of immobilization.
• Full, pain-free ROM.
• Prevent atrophy

RESTRICTIONS:

• Avoid external rotation at 45 degrees and above
• Avoid overhead work or sports until minimal pain
• Avoid lifting, pushing, pulling 1-2 weeks post-op
• Avoid leaning on elbow.
• Sling may be removed in 1-2 days except for driving.

INTERVENTIONS:

• Wear sling for first 2 day.
• Monitor healing of incisions.
• Instruct in HEP.
• Discuss goals of treatment with patient.
• PROM and AAROM exercises (all planes)
  a. Pendulum
  b. Cane
  i. flexion/extension
  ii. Abduction/Adduction
  iii. ER/IR (start a 0 abduction, progress to 45, then 90)

c. Rope and Pulley

d. Wall Walking

• Strengthening
  a. Incorporate forearm, wrist, and hand exercises first day post-op
  b. Sub-maximal isometrics (all planes)
• Posterior capsule stretches (horizontal adduction in sitting)
• Self stretches for flexion
• Modalities for pain control (cryotherapy and electrical stimulation)

PHASE 2 – INTERMEDIATE PHASE (2-6 WEEKS)

GOALS:

• Normalize full ROM.
• Regain and improve strength to 4/5
• Improve neuromuscular control
• Eliminate pain and edema

INTERVENTION:
Continue with phase I exercises with the following modifications/additions:

• AROM
• Aggressive stretching
• Strengthening
  a. Isotonic dumbbell program of all shoulder and scapulo-thoracic muscles
  b. UBE
• Joint mobilization as needed
• PNF
  a. Weight shifting in quadruped
  b. Rhythmic stabilization

PHASE 3 – DYNAMIC STRENGTHENING PHASE (6-12 WEEKS)

GOALS:

• Full, pain-free ROM
• No pain or tenderness
• Strength 70% of uninvolved side
• Improve strength, power, and endurance
• Improve neuromuscular control
• Prepare patient for gradual return to previous level of functional activity.

INTERVENTIONS:
Continue with Phase 2 exercises with the following modifications/additions:

• Strengthening
  a. Theraband exercises
  b. Plyometric exercises for rotator cuff
  c. Apply manual resistance to PNF patterns
• Advanced proprioception stabilization activities

PHASE 4 – RETURN TO ACTIVITY PHASE (12-16 WEEKS)

GOALS:

• Unrestricted activity
• Maintain normal function and motion
• Strength 85% of uninvolved side

INTERVENTION:

• Initiate interval program