Latarjet Coracoid Process Transfer

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 ToleranceGoals: 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 positionMaintain elbow at or anterior to mid-axillary line when patient is supine
3. 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
4. Maintain elbow at or anterior to mid-axillary line when patient is supine
5. Therapeutic Exercise – No canes or pulleys during this phaseCodman Exercies/PendulumsElbow/Wrist/Hand Range of Motion and Grip StrengtheningIsometric Scapular Stabilization
6. Codman Exercies/Pendulums
7. Elbow/Wrist/Hand Range of Motion and Grip Strengthening
8. Isometric Scapular Stabilization
9. Heat/Ice before and after PT sessions 

Phase II (Weeks 4-10)

1. Discontinue sling immobilization at 6 weeks post-op
2. Range of Motion4-6 weeks: PROM -> FF and Abduction to tolerance, 45° External Rotation in the 30° abducted position6-10 weeks: Begin AAROM -> AROM as tolerated: ER/IR to toleranceGoals: FF/Abduction > 155⁰, ER/IR >75⁰ at 90⁰ of shoulder abduction
3. 4-6 weeks: PROM -> FF and Abduction to tolerance, 45° External Rotation in the 30° abducted position
4. 6-10 weeks: Begin AAROM -> AROM as tolerated: ER/IR to toleranceGoals: FF/Abduction > 155⁰, ER/IR >75⁰ at 90⁰ of shoulder abduction
5. Goals: FF/Abduction > 155⁰, ER/IR >75⁰ at 90⁰ of shoulder abduction
6. Therapeutic Exercise4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises6-10 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening,
7. 4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
8. 6-10 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening,
9. Modalities per PT discretion

 Phase III (Weeks 10-16)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic ExerciseContinue with scapular strengtheningContinue and progress with Phase II exercisesBegin Internal/External Rotation IsometricsPush up plus (wall, counter, knees on floor, floor)
3. Continue with scapular strengthening
4. Continue and progress with Phase II exercises
5. Begin Internal/External Rotation Isometrics
6. Push up plus (wall, counter, knees on floor, floor)
7. 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 weights8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular StabilizersReturn to sports at 6 months if approved
3. 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
4. Return to sports at 6 months if approved
5. Modalities per PT discretion