Bankart Repair Rehabiliation Protocol

GENERAL PRECAUTIONS/RESTRICTIONS

• Use of a sling only as needed or prescribed, patient dependent. (In general, patient is in sling for approximately 3 weeks)
• Restrict the arm from the following motions for 4 weeks:
  • Extension past the plane of the body.
  • External rotation greater than 0 degrees. Do not abduct and externally rotate the shoulder.
  • For posterior tears, avoid internal rotation past the body.
• No forceful passive stretching into ER or extension x 3 months following an anterior repair and into IR for a posterior repair.
• Emphasize good posture.
• Monitor all exercises to minimize substitution or compensation.

PHASE 1 – RESTRICTED MOTION, MAXIMAL PROTECTION PHASE (0-6 WEEKS)

GOALS:

• Proper healing of surgical incision sites.
• Pain and edema control
• Prevent effects of immobilization
• Maintenance of distal muscle strength
• Minimal cervical spine stiffness
• Maintenance of full elbow and wrist ROM.
• Minimal difficulty with ADL’s below shoulder height (with assistance from uninvolved extremity.)
• Patient demonstrates understanding of home exercise program.

0-2 WEEKS

• Pendulum exercises
• Perform gentle AAROM with cane→Avoid stress on the anterior capsule
  a. Forward flexion to 60 degrees
  b. ER at 20 degrees of abduction to 0 degrees
  c. IR at 20 degrees of abduction to 45 degrees
  d. Abduction to 45 degrees
• Perform ROM exercises for elbow, wrist, and hand.
• Begin isometrics, sub-maximal contraction without pain.
  a. ER
  b. IR
  c. Abduction
  d. Flexion
  e. Extension
  f. Elbow flexion with arm at side (0 degrees of abduction)
• Hand grip/ball squeeze exercises
• Cryotherapy, electrical stimulation for pain control

3-4 WEEKS

• Discontinue sling, but continue use of immobilization at night.
• Continue with week 0-2 exercises with following modifications/additions:
  a. Forward flexion to 90 degrees
  b. ER at 20 degrees of abduction to 15 degrees
  c. IR at 20 degrees abduction to 65 degrees
  d. Abduction to 90 degrees
  e. Begin horizontal abduction in week 4.

5-6 WEEKS

• Discontinue use of immobilization during sleep.
• Gradually progress all AAROM:
  a. Forward flexion to 135 degrees
  b. ER at 45 degrees abduction to 30 degrees
  c. IR at 45 degrees abduction to 60 degrees
  d. Abduction to 120 degrees
  e. Begin horizontal adduction in week 5.
• Begin light-weight isotonic shoulder exercises.
  a. IR/ER
  b. Abduction
  c. Supraspinatus
  d. Biceps
  e. Triceps
• Begin light-weight isotonic scapular strengthening.
  a. Protraction
  b. Retraction
  c. Elevation
  d. Depression
• Begin UBE with light or no resistance.
• Begin theraband exercises (IR/ER with 0 degrees of abduction).

PHASE 2 – MODERATE PROTECTION PHASE (7-14 WEEKS)

GOALS

• By 2 months (8 week):
  a. Strength 60-70%
  b. Pain-free ADLs
  c. Lift 5 pounds
  d. Return to sedentary work
• By 3 months (12 weeks):
  a. Shoulder strength 80%
  b. Carry 5 pounds
• Full ROM by week 12-14

RESTRICTIONS/PRECAUTIONS

• Do not wait for full range of motion before strengthening or be overly aggressive in pushing for all movements early.

7-9 WEEKS

• Continue with weeks 5-6 exercises with the following modifications/additions
  a. Forward flexion to 180 degrees
  b. ER at 90 degrees of abduction to 75 degrees
  c. IR at 90 degrees of abduction to 85 degrees
  d. Abduction greater than 120 degrees
• Begin diagonal strengthening (PNF)
• Progress difficulty of rotation exercises to sidelying
• Proprioceptive exercises
  a. prone on elbow
  b. quadruped stabilization
• Able to begin jogging and road cycling

10-14 WEEKS

• Continue with progressing of all exercises.
• Progress rapidly after achieving full RO without placing stress on the anterior capsule.
• Begin manual resistance program.
• Begin light PNF patterns.
• Advance to running, road, or mountain biking.
  *NO activities with forceful, ballistic arm movements.

PHASE 3 – MINIMAL PROTECTION PHASE (15-21 WEEKS)

GOALS

• Strength
  a. 80% of overhead lifting strength compared to uninvolved extremity.
  b. 80% carrying strength below shoulder height.

15-18 WEEKS