Rehabilitation Guidelines for Arthroscopic Anterior Stabilization
Post-Operative Rehabilitation Guidelines for Arthroscopic Anterior Stabilization
MAXIMAL PROTECTION PHASE
- Sling Immobilization
- Protect anterior/posterior capsule from stretch, but begin passive ROM only POD 10-14
- Supine Forward Elevation in scapular plane to 90°
- External Rotation with arm at side to 30°.
- Grip Strength, Elbow/Wrist/Hand ROM
- Do NOT perform codmans
- Begin Deltoid/Cuff Isometrics
- May remove sling for shower but maintain arm in sling position.
- Modalities PRN
MODERATE PROTECTION PHASE
- Discontinue Sling at 4-6 weeks as tolerated
- Advance to AAROM and AROM (Limit FF to 140°, ER at side to 40°)
- Begin with gravity eliminated motion (supine) and progress. Do not force ROM with substitution patterns.
- Continue Isometric exercises
- Progress deltoid isometrics
- ER/IR (submaximal) with arm at side
- Begin strengthening scapular stabilizers
MINIMAL PROTECTION PHASE
- Advance to full, painless ROM. Gentle stretching at end ROM
- Initiate ER in 45º Abduction at 10-12 weeks
- Full AROM all directions below horizontal with light resistance
- Deltoid/Cuff progress to Isotonics
- All strengthening exercises below horizontal
- Initiate when pain-free symmetric AROM.
- Progress as tolerated
- Only do strengthening 3x/week to avoid rotator cuff tendonitis
- Restore scapulohumeral rhythm.
- Joint mobilization.
- Aggressive scapular stabilization and eccentric strengthening program.
- Initiate isotonic shoulder strengthening exercises including: side lying ER, prone arm raises at 0, 90, 120 degrees, elevation in the plane of the scapula with IR and ER, lat pulldown close grip, and prone ER.
- Dynamic stabilization WB and NWB.
- PRE’s for all upper quarter musculature (begin to integrate upper extremity patterns). Continue to emphasize eccentrics and glenohumeral stabilization.
- All PRE’s are below the horizontal plane for non-throwers.
- Begin isokinetics.
- Begin muscle endurance activities (UBE).
- High seat and low resistance
- Must be able to do active shoulder flexion to 90 degrees without substitution
- Continue with agility exercises.
- Advanced functional exercises.
- Isokinetic test.
- Functional test assessment.
- Full return to sporting activities.