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SLAP Repair Rehabilitation Protocol

normal biceps labral complex arthroscopy

normal biceps labral complex picture

shoulder capsular anatomy

 

 

Phase I –Protective Phase (0 to 6weeks)

  • Maintain shoulder range of motion (ROM), diminish pain and inflammation while protecting repair of SLAP lesion.
  • Protect SLAP repair by avoiding active elbow flexion.
  • Sling: continue sling/shoulder immobilizer use for 4weeks.  Must wear sling at night.
  • Pendulum exercises.
  • Supine active assisted forward elevation (FE) to pain tolerance.
  • Once patient understands the difference between active and passive motion, the patient should start passive FE with pulleys, and given instructions for home pulley system.
  • Passive and gentle active-assisted ROM exercises
  • Flexion to 60°(week1) progress to 145 ° by week 6.
  • Elevation in scapular plane to 60°.
  • External rotation to 15 °(week 1) progress to 45 ° by week 6.
  • Internal rotation to 45 °
  • 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.

Phase II –Early Intermediate Phase(7 to 14 weeks)

  • Discontinue shoulder immobilizer.
  • Gradually progress ROM to full.
  • Flexion progress to 180° by week 10.
  • External rotation at 90° abduction to 90° by week 10.
  • Internal rotation at 90° abduction to 60° by week 10.
  • Begin increased strengthening exercises at week 10.
  • Progress ROM to functional demands (throwing etc) at week 10.

Phase III – Intermediate phase (14 to 19 weeks)

  • Patient should have full nonpainful ROM before progressing to phase III.
  • Add isometric IR, ER, and FE exercises.
  • Progress with muscle strengthening program, stretching and ROM exercises.
  • Cybex strength testing – goal >85% of contralateral side at 19 weeks.

Phase IV – Advanced Strengthening (19 to 24 weeks)

  • Patient should have full nonpainful ROM and muscular strength 75% of the contralateral side before progressing to phase IV.
  • Progressive Resistance Exercises.  Start light, progress as tolerated.
  • UBE 90°/sec-120°/sec for endurance.
  • Wall pushups, press-ups.
  • Total Gym – rows, presses, pullovers. 
  • Rockwood exercises – flex, abd, ext, add, IR, ER, rows, presses.
  • Can use dumbbells or theraband tubing for Rockwood exercises.

Phase V – Return to Activities (After 6months) (24weeks)

  • Patient should have full nonpainful ROM and muscular strength 90% of the contralateral side before progressing to phase V.
  • Work on any focal deficits.
  • Progress with sport specific training.
  • Establish home program for strength and ROM maintanence.
  • Improvement continues for 12 months post op.

For Detailed Rehabilitation protocols see:

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