Phase I (Weeks 0-6)

1. Sling immobilization at all times (in flexion, abduction and 0° of rotation) except for showering and rehab under guidance of PT
2. Range of Motion
   • Weeks 0–3: None
   • Weeks 3–6: Begin passive ROM – Restrict motion to 90° of Forward Flexion, 90° of Abduction, and 45° of Internal Rotation
3. Therapeutic Exercise
   • Elbow/Wrist/Hand Range of Motion
   • Grip Strengthening
   • Starting Week 3: Begin passive ROM activities – Codman’s, Anterior Capsule Mobilization
4. Heat/Ice before and after PT sessions

Phase II (Weeks 6-12)

1. Sling immobilization for comfort only
2. Range of Motion
   • Begin AAROM / AROM
   • Goals: 135° of Forward Flexion, 120° of Abduction, Full External Rotation
3. Therapeutic Exercise
   • Continue with Phase I exercises
   • Begin active-assisted exercises – Deltoid / Rotator Cuff Isometrics
   • Starting Week 8: Begin resistive exercises for Rotator Cuff, Scapular Stabilizers, Biceps and Triceps (keep all strengthening exercises below the horizontal plane during this phase – utilize exercise arcs that protect the posterior capsule from stress)
4. Modalities per PT discretion

Phase III (Weeks 12-16)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Advance Phase II exercises
   • Emphasize Glenohumeral Stabilization, External Rotation and Latissimus eccentrics
   • Begin UE ergometer / endurance activities
3. Modalities per PT discretion

Phase IV (Months 4-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Continue with strengthening
   • Sport / Work specific rehabilitation – Plyometric and Throwing / Racquet Program
   • Continue with endurance activities
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Sling to be worn at all times except for showering and rehab under guidance of PT
2. Range of Motion – True Passive Range of Motion Only to Patient Tolerance
   • Goals: 140° Forward Flexion, 25° External Rotation in the 30° abducted position, 60–80° Abduction in the plane of the scapula without rotation, Limit Internal Rotation to 45° with the shoulder in the 30° abducted position
   • Maintain elbow at or anterior to mid-axillary line when patient is supine
3. Therapeutic Exercise
   • No canes or pulleys during this phase
   • Codman Exercises / Pendulums
   • Elbow/Wrist/Hand Range of Motion and Grip Strengthening
   • Isometric Scapular Stabilization
4. Heat/Ice before and after PT sessions

Phase II (Weeks 4-10)

1. Discontinue sling immobilization at 6 weeks post-op
2. Range of Motion
   • 4–6 weeks: PROM → Forward Flexion and Abduction to tolerance, 45° External Rotation in the 30° abducted position
   • 6–10 weeks: Begin AAROM → AROM as tolerated; ER/IR to tolerance
   • Goals: Forward Flexion / Abduction >155°, ER/IR >75° at 90° of shoulder abduction
3. Therapeutic Exercise
   • 4–6 weeks: Begin gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
   • 6–10 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening
4. Modalities per PT discretion

Phase III (Weeks 10-16)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Continue with scapular strengthening
   • Continue and progress with Phase II exercises
   • Begin Internal/External Rotation Isometrics
   • Push up plus (wall, counter, knees on floor, floor)
3. Modalities per PT discretion

Phase IV (Months 4-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Advance strengthening as tolerated: isometrics → therabands → light weights
   • 8–12 repetitions / 2–3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Sling immobilization to be worn at all times except for showering and rehab under guidance of PT
2. Range of Motion – PROM → AAROM → AROM of elbow as tolerated without resistance (allows biceps tendon to heal into new insertion on the humerus without being stressed), AROM of shoulder (no restriction)
   • Goals: full passive flexion/extension at elbow and full shoulder AROM
   • Encourage pronation/supination without resistance
   • Grip strengthening
3. Heat/Ice before and after PT sessions

Phase II (Weeks 4-12)

1. Discontinue sling immobilization
2. Range of Motion
   • Begin AROM of elbow with passive stretching at end ranges to maintain/increase elbow/biceps flexibility
3. Therapeutic Exercise
   • Begin light isometrics with arm at side for rotator cuff and deltoid – can advance to bands as tolerated
   • Begin light resistive biceps strengthening at 8 weeks
4. Modalities per PT discretion

Phase III (Months 3-6)

1. Range of Motion – Progress to full AROM of elbow without discomfort
2. Therapeutic Exercise
   • Continue and progress with Phase II exercises
   • Begin UE ergometer
   • Begin sport-specific rehabilitation
   • Return to throwing at 3 months
   • Throwing from a mound at 4.5 months
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Sling immobilization at all times except for showering and rehab under guidance of PT
2. Range of Motion – AAROM → AROM as tolerated
   • Restrict motion to 140° of Forward Flexion, 40° of External Rotation and Internal Rotation to stomach
   • No Internal Rotation up the back / No External Rotation behind the head
3. Therapeutic Exercise
   • Wrist/Hand Range of Motion
   • Grip Strengthening
   • Isometric Abduction, Internal/External Rotation exercises with elbow at side
   • No resisted Forward Flexion / Elbow Flexion (to avoid stressing the biceps origin)
4. Heat/Ice before and after PT sessions

Phase II (Weeks 4-6)

1. Discontinue sling immobilization
2. Range of Motion – Increase Forward Flexion, Internal/External Rotation to full motion as tolerated
3. Therapeutic Exercise
   • Advance isometrics from Phase I to use of a theraband within AROM limitations
   • Continue with Wrist/Hand Range of Motion and Grip Strengthening
   • Begin Prone Extensions and Scapular Stabilizing Exercises (traps/rhomboids/levator scapula)
   • Gentle joint mobilization
4. Modalities per PT discretion

Phase III (Weeks 6-12)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Advance theraband exercises to light weights (1–5 lbs)
   • 8–12 repetitions / 2–3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
   • Continue and progress with Phase II exercises
   • Begin UE ergometer
3. Modalities per PT discretion

Phase IV (Months 3-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise
   • Advance exercises in Phase III (strengthening 3x per week)
   • Sport/Work specific rehabilitation
   • Return to throwing at 4.5 months
   • Return to sports at 6 months if approved
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Sling immobilization for comfort Weeks 0-2 – Discontinue sling use at 2 weeks
2. Range of Motion – PROM → AAROM → AROM as tolerated
   • Goals: 140° of Forward Flexion, 40° of External Rotation at side, Internal Rotation behind back with gentle posterior capsular stretching
   • No abduction-external or internal rotation (90/90) until 4-8 weeks post-op
3. Therapeutic Exercise
   • Codman’s / Pulleys / Cane
   • Elbow/Wrist/Hand Range of Motion
   • Grip Strengthening
   • No resistive exercises
4. Heat/Ice before and after PT sessions

Phase II (Weeks 4-8)

1. Range of Motion – Increase Forward Flexion, Internal/External Rotation to full motion as tolerated
   • Goals: 160° of Forward Flexion, 60° of External Rotation at side, Internal Rotation behind back and at 90° of abduction with gentle posterior capsular stretching
2. Therapeutic Exercise
   • Begin light isometrics with arm at the side for rotator cuff and deltoid
   • Advance to therabands as tolerated
   • Passive stretching at end range of motion to maintain shoulder flexibility
3. Modalities per PT discretion

Phase III (Weeks 8-12)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Advance strengthening as tolerated
   • Isometrics → therabands → weights
   • Begin eccentrically resisted motions, closed chain exercises and plyometrics
   • 8–12 repetitions / 2–3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
3. Modalities per PT discretion