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TSA Rehabilitation Protocol

 Goal:  Regain shoulder ROM

  • Because the subscapularis tendon is taken down and then repaired, ER is limited early in the protocol to 20 degrees or as specified by orthopaedic surgeon.
  • There is no limit to the flexion ROM.
  • Full recovery takes 6 to 12 months

Phase I (0 to 6 Days)

  • Active assisted ROM with pulleys for forward elevation (FE).
  • Passive ROM FE, IR.
  • Pendulum exercises.
  • Elbow, wrist, and finger active ROM exercise.
  • Educate patient on the above exercises for home.
  • No ER past 20 degrees or as indicated by orthopaedic surgeon.
  • Patients must remain in shoulder immobilizer at all times when not doing PT.

Phase II (7 to 20 Days)

  • Add shoulder extension exercises.
  • Begin assisted IR exercises behind back
  • POD #14 – Add isometric exercises for ER, and ABD.
  • Continue pulley FE exercises.

Phase III  (3 to 6 Weeks)

  • Add ER exercise.  Limit ER to 30 degrees.
  • Patients may use shoulder sling instead of shoulder immobilizer.

Phase IV (6 to 12 Weeks)

  • Work to gain full ROM.
  • ER with resistance.  Full ER permitted.
  • Rotator cuff, deltoid, and subscapularis strengthening.
  • Discontinue sling.

Phase V (3 to 6 Months)

  • Establish a home program so patient continues PT until at least 6 month post op.
  • Work on an residual focal deficits.