Meet Our Physicians       Patient Education       Patient Registration       Post-Op Instructions       Special Precautions       Rehab Protocols       Links of Interest	Planning for Surgery Rehabilitation Protocol: SHOULDER INSTABILITY RECONSTRUCTION This program is designed as a guide for both the patient and therapist for shoulder instability involving the fixation of the labrum and capsule to bone, and includes those performed either open or arthroscopically. Important variables with the surgical procedure include: Primary or revision case Trade-off between motion and the healing of tissue. PREOPERATIVE PHYSICAL THERAPY: Preoperative orientation visit, review protocol Instructions on placement of immobilizer/sling and proper icing techniques. Instruction in home exercise program (fingers, wrist, elbow and pendulum) Schedule first post-op physical therapy visit beginning 7-10 days after surgery. POSTOPERATIVE PHYSICAL THERAPY: Phase 1: Immediately post-op to 3 weeks Goals: To begin movement of fingers, wrist and elbow. To decrease pain and swelling in the shoulder. Protect the reconstruction. Brace: The sling/immobilizer MUST be worn at all times except for therapy and personal hygiene. Therapeutic exercises: Active ROM fingers, wrist and elbow with arm at side Begin active shoulder pinches (scapular retraction) Avoid shoulder adduction across body and shoulder extension Watch for signs of RSD Begin isometric IR only Continue icing program Phase 2: 3-6 weeks Goals: To improve active shoulder ROM, functional mobility, limit pain, and begin light strengthening. May not lift more than a coffee cup. Brace: Change to sling at 4 weeks. Discontinue at 6 weeks. Limitations: All motion should be anterior to the scapular plane at or below shoulder level. No stretching prior to 6 weeks. Therapeutic exercises: Passive ROM in scapular plane below 90º (abduction and forward flexion) Passive shoulder internal and external rotation as directed by the physician Continue home program Discourage scapular compensation with forward flexion and abduction Active ROM forward flexion limit to 90º Active abduction in scapular plane limit to 90º Gravity eliminated internal Begin ER/IR strengthening with rubber tubing/straps at 4 weeks Wand ROM - flexion in supine position (begin at 4 weeks) to 90º Gravity eliminated external rotation (begin at 4 weeks) No lifting of heavy objects causing axial traction Emphasize isometric IR Phase 3: 6-10 weeks Goals: Progress Active ROM and strength towards normal ROM Therapeutic exercises: Prone pendulum Begin overhead pulley system for AAROM Begin IR/ER stretches (terminal stretching at 9 weeks) Begin strengthening with rubber tubing/straps Side-lying IR and ER strengthening with weights Begin low-level isometrics for shoulder flexion, extension, abduction, IR and ER Progress functional use of arm to allow patient to use arm anterior to scapular plane Avoid impingement positions Phase 4: 10-12 weeks Goals: Attain full ROM by 12 weeks Therapeutic exercises: Continue strengthening (scapular stabilizers, latissimus dorsi, trapezius) Golfers may begin putting at 10 weeks May begin formal weight-training after 12 weeks (no bench press work and all work anterior to scapular plane) May begin light toss/throwing program after 16 weeks Golfers may begin light full swing after 16 weeks ***Notice*** Return to full sports usually at 5-6 months but must be cleared by the physician. Patients wishing to participate in activities requiring high shoulder angular acceleration (golf, tennis and baseball) should be advised that they could anticipate return after 6 months.