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 Exercises / 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: Begin 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
