Shoulder Arthroscopy Combined Arthoscopic Labrum Repair Rehabilitation Protocol

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1 LUKE S. CHOI, M.D N. Outer Forty Road, Suite 360 Chesterfield, MO Office: (314) Fax: (314) Shoulder Arthroscopy Combined Arthoscopic Labrum Repair Rehabilitation Protocol Post-Op phase Sling Range of Motion Therapeutic exercises Precautions Phase 1 0 to 4 weeks after surgery Allow healing of repaired capsule. Initiate early protected and restricted range of motion. Minimize muscular atrophy. Decrease pain/inflammation. 5 to 6 weeks after surgery Gradual increase in ROM Improve strength Decrease pain/inflammation Phase 2 7 to 12 weeks after surgery Gradually restore range of motion Increase strength Improve neuromuscular control Enhance proprioception and kinesthesia Decrease pain/inflammation Per MD Weeks 0-2: Flexion ERN limit 5-10º Weeks 2-4: Flexion to 120 degrees as tolerated 0º: No IR behind back No ABD No horizontal adduction 5-6 Weeks: ER/IR in plane of scapula: 30º Flexion to 145º as tolerated 0º: 30 D/C ER at 45º Abduction=50º Shoulder flexion to tolerance (165 º by week 8) IR in plane of scapula: 60 IR at 90º abduction to 30-45º by starting at week 10 Progress cautiously and gradually to 60-65º by week 12 Week 7: ER at 90 degrees abduction: 70º Weeks 8-9: ER to 80º at 90º abduction No stretching 0-4 weeks Pendulum exercises Supine forward flexion with wand Supine ER at neutral Scapular shrugs/retraction 5-6 Weeks: Standing ERN stretch Gradually improve ROM all planes Elevation in scapular plane Wall slide IR behind back to beltline only start week 8 Horizontal adduction reach only start week 8 scapular plane Hands behind head starts week 9 postop Overhead pully Isometrics: ER, IR, FLX, EXT, ABD Rythmic stabilization for IR/ER, FLX/EXT Propriocetion drills Ball squeeze Elbow and forearm exercises 5-6 Weeks: Side lying ER 0-30 Prone row Prone extension to hip Standing FF to 90º Theraband Exercises: ER, IR (limit IR to neutral) Theraband Exercises: Continue previoius exercises. Add: Shrug, Dynamic hug, W s. Biceps curl (week 9 with SLAP) Row (week 11 with SLAP) Forward punch (serratus punch) Dynamic exercises: PRE 1-3 lb as tolerated Continue phase1 Add: *Side-lying scaption *Prone T s *Standing scaption *Isotonic biceps curl *Prone Y s *Rhythmic stabilization No internal rotation No horizontal adduction No closed chain positions No activities above head. Avoid ER in abduction Caution to avoid excessive shoulder extension Gradual ROM for IR behind back, IR+ER at 90º abduction and horizontal adduction No push-ups or pushing movements Avoid excessive extension, and ER 0º =45-60 *Propriocetion drills *Scapulohumeral Rhythm exercises

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3 PHASE ONE (0-6 Weeks After Surgery) Protect the repair Ensure wound healing Prevent shoulder stiffness Decrease pain/inflammation Activities: SLING: Use your sling as instructed by your doctor. If you remove the sling, be careful and keep the shoulder safe. The sling must be worn at all times with the exception of exercise activity nad bathing. Keep the sling on when sleeping at night for the first four weeks. USE OF OPERATIVE ARM: You may use your hand on the operated arm as long as you DO NOT raise the hand above your head or reach across the front of your body. Also, do not reach your hand behind you as if to tuck in your shirt or to loop your belt. You should bend your arm at the elbow and use your fingers and hand, such as to reach up and touch your face. Keep your elbow in front of you. Do not bear the weight of the body on your arm. BATHING AND SHOWERING: You may shower or bath and wash the incision area. To wash under the operated arm, bend over at the waist and let the arm passively swing away from the body. It is safe to wash under the arm in this position. This is the same position as the pendulum exercise. Do not submerge the incisions under water ICE: As necessary minutes per day for 7 days. Avoid direct contact with skin. Stretching and PASSIVE Range of Motion: PROGRAM: o Pendulum Exercises o Supine External Rotation Limit 5-10 degrees (Weeks 0-2) Limit degrees (Weeks 3-4) Limit 30 degrees (Weeks 5-6) o Supine Forward Arm Elevation Limit degrees (Weeks 0-2) Limit 120 degrees (Weeks 3-4) Limit 145 degrees (Weeks 5-6) o NO INTERNAL ROTATION o NO HORIZONTAL ADDUCTION o AVOID ER IN ABDUCTION o CAUTIONT TO AVOID EXCESSIVE SHOULDER EXTENSION Gentle Strengthening Exercises: PROGRAM (Weeks 0-4) o Isometric exercises: Internal and external rotation at neutral; flexion, extension and abduction. o Rhythmic stabilization and proprioceptive training drills with physical therapist. o Ball squeeze exercise. o No weight bearing exercise or activities PROGRAM (Weeks 5-6) o Theraband Internal (To Neutral Only) and External Rotation o Prone row o Prone extension o Standing Scapation (Forward elevation to 90 degrees) o Side-lying external rotation o Rhythmic stabilization and proprioceptive training drills with physical therapist. NO CLOSED CHAIN POSITIONS NO ACTIVITIES OVERHEAD

4 PHASE TWO (7-12 Weeks After Surgery) Protect the shoulder repair Regain full range of motion Continue gentle strengthening Rehabilitation after Combined Arthroscopic Labrum Repair Activities: USE OF OPERATIVE ARM: You may now use your arm in a more normal fashion. You may move the arm into all positions including external rotation and behind the back if it is comfortable. Avoid having the arm forcefully pulled behind you. Continue to avoid heavy weight lifting or manual labor. Follow any further instructions given to you by your doctor. PRECAUTIONS: Do not lift heavy weights overhead with the weight going behind the head. In other words, keep the weights in front of you where you can see them. Range of Motion Exercises: Pendulum Exercises Standing External Rotation/Doorway Wall Slide Stretch Hands-Behind-Head Stretch o Starting the 9th week after surgery Standing Forward Flexion Behind the Back Internal Rotation o Starts after 8 th week after surgery Horizontal Adduction stretch o Starts after 8 th week after surgery Strenghtening/Dynamic Exercises: Side-lying External Rotation Prone Horizontal Abduction T s Prone Scaption Y s Prone Row Prone Extension Standing Scaption Full-Can Exercise Rhythmic Stabilization and Proprioceptive Training Drills with Physical Therapist Strengthening/Theraband Exercises: External Rotation Internal Rotation Standing Forward Punch Shoulder Shrug Dynamic Hug W s Seated Row Biceps Curl

5 PHASE THREE (13 to 20 Weeks After Surgery) Protect the ligament repair Regain full range of motion Continue strengthening Gradual return to full activity Rehabilitation after Combined Arthroscopic Labrum Repair Activities: Use the arm for normal daily activities, but continue to be cautious to avoid excessive or forceful reaching across the front of the body. Also be cautious when reaching behind your body. Continue to avoid bearing weight as if pushing open a door or doing a push-up. Range of Motion Exercises: Standing External Rotation/Doorway Wall Slide Stretch Prone External Rotation at 90 Abduction U s Hands-Behind-Head Stretch Biceps Curl Behind-The-Back Internal Rotation Supine Cross-Chest Stretch Sidelying Internal Rotation External Rotation at 90 Abduction Stretch Strengthening/Theraband Exercises: Continue exercises from Phase 3 (Optional exercises) External Rotation at 90 Internal Rotation at 90 Standing T s Diagonal Up Diagonal Down Strenghtening/Dynamic Exercises: Resisted Forearm Supination-Pronation Resisted Wrist Flexion-Extension PNF Manual Resistance with Physical Therapist Push-up progression beginning with Wall Push-Up

6 PHASE FOUR (21 TO 28 Weeks After Surgery) Progression of Functional Activities Maintain Full Range of Motion Continue Progressive Strengthening Range of Motion Exercises: Continue from previous phase Strengthening/Theraband Exercises: Continue from previous phase Strenghtening/Dynamic Exercises: Continue from previous phase Plyometric Exercises: May progress weight bearing program Rebounder s throws with arm at side Wall dribbles overhead Rebounder throwing/weighted ball Wall dribbles at 90 degrees Wall dribble circles Weight Training: See weight training precautions section Progress per MD instructions Interval Sports Program May begin with clearance from your doctor. Rehabilitation after Combined Arthroscopic Labrum Repair

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