Phase I (Weeks 0-4)
- Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of PT
- Range of Motion – True Passive Range of Motion Only to Patient Tolerance
- Goals: 140° Forward Flexion, 40° External Rotation with elbow at side, 60-80° Abduction without rotation, Limit Internal Rotation to 40° with the shoulder in the 60-80° abducted position
- Maintain elbow at or anterior to mid-axillary line when patient is supine
- Therapeutic Exercise – No canes or pulleys during this phase
- Codman Exercies/Pendulums
- Elbow/Wrist/Hand Range of Motion and Grip Strengthening
- Isometric Scapular Stabilization
- Heat/Ice before and after PT sessions
Phase II (Weeks 4-8)
- Discontinue sling immobilization
- Range of Motion
- 4-6 weeks: Gentle passive stretch to reach ROM goals from Phase I
- 6-8 weeks: Begin AAROM -> AROM as tolerated
- Therapeutic Exercise
- 4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
- 6-8 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening**
- Modalities per PT discretion
Phase III (Weeks 8-12)
- Range of Motion – Progress to full AROM without discomfort
- Therapeutic Exercise
- Continue with scapular strengthening
- Continue and progress with Phase II exercises
- Begin Internal/External Rotation Isometrics
- Stretch posterior capsule when arm is warmed-up
- Modalities per PT discretion
Phase IV (Months 3-6)
- Range of Motion – Full without discomfort
- Therapeutic Exercise – Advance strengthening as tolerated: isometrics -> therabands -> light weights (1-5 lbs),
- 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
- Return to sports at 6 months if approved
- Modalities per PT discretion
Comments:
**IF BICEPS TENODESIS WAS PERFORMED – NO BICEPS STRENGTHENING UNTIL 8 WEEKS POST-OP