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Shoulder Arthroscopy Rehab Protocol

 

Includes Subacromial Decompression Rehab Protocol, Distal Clavicle Resection Rehab Protocol and Diagnostic arthroscopy Rehab Protocol. Stable shoulder with intact RTC required.

Phase I –Protective Phase (0 to 4weeks)

  • Goals: Maintain shoulder range of motion (ROM), diminish pain and inflammation.
  • Sling: for comfort only, may discontinue as tolerated. Sling should be discontinued by 2 weeks.
  • Active and Active-assisted ROM.
  • Flexion to 140°.
  • Abduction to 60°.
  • External rotation to 40 °.
  • Capsular stretching (anterior, posterior, inferior)
  • Use modalities to control pain and swelling (i.e. cryotherapy, HVGS, TENS).
  • Home exercise program should be established so patient performs exercises 3-5 times per day.
    -Pendulum exercises, elbow, wrist, hand motion and strength maintenance.
    -Putty for hand and grip strength.
    -Pulley exercises: flexion to 90°, slowly progress flexion to 140º.
    -Active Assisted ROM (AAROM): flexion and extension with cane.

Phase II - Intermediate Phase (4-8 weeks)

  • Goals: Advance ROM to full active ROM, begin strengthening, eliminate pain and inflammation.
  • Exercise:  (Work within pain-free range of motion)
  • Begin strengthening exercises of rotator cuff and scapular stabilizers
  • Begin with isometrics (shoulder: flex, abd, add, ext, IR, ER & elbow: flex/ext/sup/pron).  Shoulder circumduction, shrugs, etc.
  • Progress to dynamic motion with Therabands.
  • Limit active resisted abduction and flexion to <90 degrees
  • Shoulder IR, ER, flex, ext, abd, add
  • Elbow flexion and extension, rows/presses, PNF patterns
  • Active ROM.
  • Flexion to 160°.
  • Abduction to 80°.
  • External rotation to 60°.
  • Internal rotation to 45° (L1).
  • Capsular stretching (anterior, posterior, inferior)
  • Use modalities to control pain and swelling (i.e. cryotherapy, HVGS, TENS).
  • Avoid any cross-body adduction exercises for patients with distal clavicle resections.

Phase III – Advanced Strengthening (6 to 12 weeks)

  • Goals: Full active ROM, progressive strengthening, gradual return to full activities.
  • Exercise: (Advance as tolerated)
  • Progressive strengthening of rotator cuff and scapular stabilizers
  • All strengthening should be within the PAIN FREE range of motion.  Good posture should be emphasized to maintain shoulder in optimal position to avoid impingement
  • Aggressive shoulder capsular stretching, emphasizing the posterior capsule.  Arm stretched into horizontal adduction.
  • Wall pushups/Incline pushups
  • Chair dips
  • Total gym
  • Plyometric exercises
  • Begin sport specific rehab program.
  • Patients with distal clavicle resections may begin cross-body adduction exercises.

12 weeks)Triceps pressdownsPhase IV – Return to Activities (After

  • Goals: full painless active ROM, unrestricted activity
  • Teach home shoulder strengthening program.
  • Advance sport specific rehab

For Detailed Rehabilitation protocols see:

  • Brotzman SB, Clinical Orthopaedic Rehabilitation, Mosby, 2003.