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Anterior-Inferior Instability Rehab Protocol

Goal

  • Reestablish full function of shoulder without stressing anterior capsule.
  • May return to contact sports and weightlifting at 6 months; full recovery may take 1 year

Phase I – Protective / Early Range of Motion (0 to 3 weeks)

Goals

  • Early range of motion to prevent stiffness
  • Allow healing of repair

Exercise (perform exercises 3 times daily)

  • Active assisted flexion with pulleys – progressively increase to 90º
  • Pendulums
  • AAROM shoulder ER to neutral (0º).  Use a cane or other hand.
  • AROM of elbow (flex, extend, supinate, pronate), wrist, and hand (putty)
  • NO ACTIVE ABDUCTION OR EXTERNAL ROTATION during first 6 weeks.
  • Patient should wear sling .

Phase II – Recovery of Range of Motion (3 to 6 weeks)

Goals

  • Improve range of motion
  • Gentle strength

Exercise:  (Isometrics should be sub maximal, sub painful contractions)

  • Isometric ER with elbow at side and forearm on stomach
  • Isometric abduction with elbow at side
  • Isometric biceps flexion
  • Increase AAROM flexion with pulleys to 140º
  • Begin adduction stretching, with arm pulled across body
  • Discontinue sling use at 6 weeks.

Phase III – Advanced ROM (6 to 9 weeks)

Goals

  • Increased ROM
  • Continue gentle strength

Exercise:

  • AAROM ER with elbow at side to 40º
  • AAROM abduction to 90º
  • IR stretching (towel behind back, slide cane up back, etc.)
  • Increase flexion with pulleys to equal other shoulder

Phase IV – Strength (9 to 16 weeks)

Goals

  • Approaching full range of motion
  • Clinic and home based strength program

Exercise:

  • Rotator cuff strength.  Progress as tolerated and as strength improves
  • Upper Body Ergometer (UBE)
  • Total Gym
  • Lat pulls
  • Seated Rows
  • Plyoball rebounder
  • Incline pushups
  • Chair dips
  • Increase active abduction to equal other shoulder
  • Work on any focal deficits

Discharge (16+ weeks)

Goals

  • Full active range of motion without pain

Exercise:

  • Full, unrestricted activity
  • Regular shoulder and rotator cuff strength as maintenance program