Download Arthroscopic Anterior Stabilization Rehab Protocol

0-4 Weeks: MAXIMAL PROTECTION PHASE

  • Sling Immobilization
  • Protect anterior/posterior capsule from stretch, but begin passive ROM only POD 10-14
    • Supine Forward Elevation in scapular plane to 90°
    • External Rotation with arm at side to 30°
  • Grip Strength, Elbow/Wrist/Hand ROM
  • Do NOT perform codmans
  • Begin Deltoid/Cuff Isometrics
  • May remove sling for shower but maintain arm in sling position.
  • Modalities PRN

4-8 Weeks: MODERATE PROTECTION PHASE

  • Discontinue Sling at 4-6 weeks as tolerated
  • Advance to AAROM and AROM (Limit FF to 140°, ER at side to 40°)
  • Begin with gravity eliminated motion (supine) and progress. Do not force ROM with substitution patterns
  • Continue Isometric exercises
    • Progress deltoid isometrics
    • ER/IR (submaximal) with arm at side
  • Begin strengthening scapular stabilizers

8-12 Weeks: MINIMAL PROTECTION PHASE

  • Advance to full, painless ROM. Gentle stretching at end ROM
  • Initiate ER in 45º Abduction at 10-12 weeks
  • Full AROM all directions below horizontal with light resistance
  • Deltoid/Cuff progress to Isotonics
  • All strengthening exercises below horizontal

3-12 Months: STRENGTHENING PHASE

  • Initiate when pain-free symmetric AROM
  • Progress as tolerated
  • Only do strengthening 3x/week to avoid rotator cuff tendonitis
  • Restore scapulohumeral rhythm
  • Joint mobilization
  • Aggressive scapular stabilization and eccentric strengthening program
  • Initiate isotonic shoulder strengthening exercises including: side lying ER, prone arm raises at 0, 90, 120 degrees, elevation in the plane of thescapula with IR and ER, lat pulldown close grip, and prone ER
  • Dynamic stabilization WB and NWB
  • PRE’s for all upper quarter musculature (begin to integrate upper extremity patterns). Continue to emphasize eccentrics and glenohumeral stabilization
  • All PRE’s are below the horizontal plane for non-throwers
    • 1) Begin isokinetics
    • 2) Begin muscle endurance activities (UBE)
      • i. High seat and low resistance
      • ii. Must be able to do active shoulder flexion to 90 degrees without substitution
    • 3) Continue with agility exercises
    • 4) Advanced functional exercises
    • 5) Isokinetic test
    • 6) Functional test assessment
    • 7) Full return to sporting activities

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.