Phase I: 1 through 4 to 6 weeks post-op:
First 3 weeks:
- Patient education: movement limitations, posture, proper sling fitting, joint protection, and positioning
- Elbow/wrist/hand AROM w/ no resistance
- PROM shoulder flexion/abduction/ER/IR
- Light active scapular strengthening exercises
- STM to rotator cuff, scapular, and deltoid mm
- Pendulum hangs
- Modalities PRN
Weeks 3-4 or 6 as tolerated:
- Progress pendulum hangs to pendulum circles based on tolerance
- Progress scapular strengthening
- Continue with PROM shoulder flex/abd/IR/ER
- Joint mobilizations grades I and II for pain relief at GH/SC/AC/ST joints
- Modalities PRN
Phase II: Weeks 6-12
- Continue PROM as needed
- Initiate AAROM program and progress to AROM as tolerated
- Pulleys, cane exercises, table slides, wall slides etc. in multiple planes
- Progress joint mobilizations at GH/SC/AC/ST joint to grades III and IV as needed
- Posterior capsule stretching
- Begin low-level closed chain shoulder exercises
- Initiate deltoid and non-repaired mm of RTC strenthening program when appropriate (pain-free and full AROM)
- Continue scapular strengthening/stabilization exercises
- Modalities PRN
Phase III: Weeks 12 through discharge:
- Progress closed chain exercises
- Initiate balanced progressive RTC strengthening program
- Ensure exercises are pain-free and are performed with no substitutions and adequate ROM
- Dynamic scapular stabilization exercises
- Exercises focusing on safe return to ADL's/work/recreational activies as tolerated
- Upon discharge, ensure patient continues HEP for at least 6-8 weeks