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

Phase I (Weeks 0-4)

1. Sling immobilization with supporting abduction pillow 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, 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
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 4-8)

1. Discontinue sling immobilization
2. Range of Motion
   • 4–6 weeks: Gentle passive stretch to reach ROM goals from Phase I
   • 6–8 weeks: Begin AAROM → AROM as tolerated
3. Therapeutic Exercise
   • 4–6 weeks: Begin gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
   • 6–8 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 8-12)

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
   • Stretch posterior capsule when arm is warmed-up
3. Modalities per PT discretion

Phase IV (Months 3-6)

1. Range of Motion – Full without discomfort
2. 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
3. Modalities per PT discretion

Comments

• IF BICEPS TENODESIS WAS PERFORMED – NO BICEPS STRENGTHENING UNTIL 8 WEEKS POST-OP

Phase I (Weeks 0-6)

1. Sling immobilization for first 6 weeks–out of sling to do home exercise program (pendulums) twice daily
2. Therapeutic Exercise
   • Grip Strengthening
   • Elbow/Wrist/Hand Exercises
   • Teach Home Exercises — Pendulums
3. Heat/Ice before and after PT sessions

Phase II (Weeks 6-12)

1. Discontinue sling
2. Range of Motion – PROM -> AAROM -> AROM – increase as tolerated
   • Begin Active Internal Rotation and Backward Extension as tolerated
   • Goals: >90° Forward Flexion and 30° External Rotation
3. Therapeutic Exercise
   • Begin light resisted exercises for Forward Flexion, External Rotation and Abduction – isometrics and bands – Concentric Motions Only
   • No Resisted Internal Rotation, Backward Extension or Scapular Retraction
4. Modalities per PT discretion

Phase III (Months 3-12)

1. Range of Motion – Progress to full AROM without discomfort – gentle passive stretching at end range
2. Therapeutic Exercise
   • Begin resisted Internal Rotation and Backward Extension exercises
   • Advance strengthening as tolerated – Rotator Cuff, Deltoid and Scapular Stabilizers
   • Begin eccentric motions, plyometrics and closed chain exercises
3. Modalities per PT discretion

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant meniscal repair, meniscal transplant, or articular cartilage procedure is performed)
2. Hinged Knee Brace
   • Locked in full extension for ambulation and sleeping (Weeks 0–1)
   • Unlocked for ambulation and removed while sleeping (Weeks 1–4)
3. Range of Motion – AAROM → AROM as tolerated
4. Therapeutic Exercises
   • Quad / Hamstring sets
   • Heel slides
   • Non-weightbearing stretch of the Gastroc / Soleus
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag

Phase II (Weeks 4-6)

1. Weightbearing: As tolerated — discontinue crutch use
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion
4. Therapeutic Exercises
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Progress to weightbearing stretch of the Gastroc / Soleus
   • Begin use of the stationary bicycle

Phase III (Weeks 6-16)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening and proprioception activities
   • Begin use of the Stairmaster / Elliptical
   • Start straight-ahead running at 12 weeks

Phase IV (Months 4-6)

1. Gradual return to athletic activity as tolerated
2. Maintenance program for strength and endurance

Phase I (Weeks 0-4)

1. Weightbearing: As tolerated with crutches (may be modified if concomitant meniscal repair, meniscal transplant, or articular cartilage procedure is performed)
2. Hinged Knee Brace
   • Locked in full extension for ambulation and sleeping (Weeks 0–1)
   • Unlocked for ambulation and removed while sleeping (Weeks 1–4)
3. Range of Motion – AAROM → AROM as tolerated
4. Therapeutic Exercises
   • Quad / Hamstring sets and heel slides
   • Non-weightbearing stretch of the Gastroc / Soleus
   • Straight-leg raise with brace in full extension until quad strength prevents extension lag

Phase II (Weeks 4-6)

1. Weightbearing: As tolerated — discontinue crutch use
2. Hinged Knee Brace: Discontinue brace use when patient has achieved full extension with no evidence of extension lag
3. Range of Motion – Maintain full knee extension; work on progressive knee flexion
4. Therapeutic Exercises
   • Closed-chain extension exercises
   • Hamstring curls
   • Toe raises
   • Balance exercises
   • Progress to weightbearing stretch of the Gastroc / Soleus
   • Begin use of the stationary bicycle

Phase III (Weeks 6-16)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening and proprioception activities
   • Begin use of the Stairmaster / Elliptical
   • Start straight-ahead running at 12 weeks

Phase IV (Months 4-6)

1. Continue strengthening (quad / hamstring) and flexibility
2. Begin cutting exercises and sport-specific drills
3. Maintenance program for strength and endurance
4. Return to sports at 6 months