1-4 Weeks:
- Sling Immobilization
- Active ROM Elbow, Wrist and Hand
- True Passive (ONLY) ROM Shoulder. NO ACTIVE MOTION
- Pendulums
- Supine Elevation in Scapular plane = 140 degrees
- External Rotation to tolerance with arm at side. (emphasize ER, minimum goal 40°)
- Scapular Stabilization exercises (sidelying)
- Deltoid isometrics in neutral (submaximal) as ROM improves
- No Pulley/Canes until 6 weeks post-op (these are active motions)
4-6 Weeks:
- Discontinue sling use
- Begin Active Assist ROM and advance to Active as Tolerated
- Elevation in scapular plane and external rotation as tolerated
- No Internal rotation or behind back until 6wks
- Begin Cuff Isometrics at 6wks with arm at the side
6-12 Weeks:
- Active Assist to Active ROM Shoulder As Tolerated
- Elevation in scapular plane and external rotation to tolerance
- Begin internal rotation as tolerated
- Light stretching at end ranges
- Cuff Isometrics with the arm at the side
- upper Body Ergometer
3-12 Months:
- Advance to full ROM as tolerated with passive stretching at end ranges
- Advance strengthening as tolerated: isometrics — bands — light weights (1-5 lbs); 8-12 reps/2-3 sets per rotator cuff, deltoid, and scapular stabilizers
- Only do strengthening 3x/week to avoid rotator cuff tendonitis
- Begin eccentrically resisted motions, pylometrics (ex. Weighted ball toss) proprioception (es. body blade)
- Begin sports related rehab at 4 ½ months, including advanced conditioning
- Return to throwing at 6 months
- Throw from pitcher’s mound at 9 months
- Collision sports at 9 months
- MMI is usually at 12 months post-op
Please note that these instructions are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Nwachukwu supersede the instructions below and should be followed.
