Rehabilitation Protocol for Arthroscopic Repair

PHASE I - The Protection Phase

Weeks 0 - 4
Bracing
  • Wear immobilizer at all times
  • Sleep with pillow behind elbow
Exercise
  • Stretch wrist flexors & extensors (hold for 10 seconds, repeat 10 times)
  • Grip putty or soft-ball & squeeze (frequently throughout day)
Weeks 4 - 6
Bracing
  • Continue wearing immobilizer/sling at all times, continue pillow behind elbow
  • May come out of immobilizer for exercises
Exercise
  • Perform all exercises to tolerance (take to point of pain and/or resistance and hold)
  • Continue wrist stretching & gripping exercises
  • Codman Pendulum exercises (bend over & stir the pot with SMALL circles, 2 minutes x 3 per day)
  • Rope & Pulley exercises: Shoulder forward-flexion to 60°, abduction to 45°
  • Begin progressive resistance exercises (PRE) for elbow (1 - 5 pounds)
  • Biceps Curl: (hold for 2 seconds and fully extend arm, increase hold time, and number of reps daily)
  • French Curl: (hold for 2 seconds and slowly lower arm, increase hold time and number of reps daily
  • Wrist Curls, supinated & pronated: (hold for 2 seconds and slowly lower wrist)
  • Begin conditioning program for trunk, lower extremities & cardiovascular system

PHASE II - ROM Phase

Weeks 6 - 8
Bracing
  • Wear sling as needed for comfort
  • May discontinue night bracing
Exercise
  • Continue all the above, increase hold time, # reps. DO NOT increase weights!!!
  • PROM/AAROM: Shoulder forward-flexion to 90°, Abduction to 90°, Int Rot to 45° at 90° shoulder abduction, Shoulder horizontal abduction & adduction to tolerance
  • Supine T-bar exercises (same limits as above)
  • Therband ER & IR at 0° shoulder abduction (hold 2 seconds with slow return to starting point)
  • Aquatherapy: Twist at 30° abduction, Bobing
Weeks 8 - 10
Bracing
  • Discontinue all bracing
Exercise
  • Continue all the above, Perform all exercises to tolerance (take to point of pain and/or resistance and hold) , may increase weight to 10 pounds maximum.
  • PROM/AAROM limits: FF to 160°, ABD to 120°, IR/ABD to 90°/90° position, ER/ABD to 90°/90°
  • Begin Active-supine ROM to tolerance.
  • Begin progressive resistance exercises (PRE) for Shoulder (weight 0 - 5 pounds)
  • Shoulder forward-flexion: (hold all for 2 seconds, increase time and number of reps daily)
  • Shoulder Abduction
  • Supraspinatus empty can lift
  • Prone extension
  • Prone horizontal abduction
  • Side-lying external rotation
  • Shoulder Shrugs
  • Progressive push-ups
  • Continue Conditioning Program, may begin jogging
  • Begin Therband Exercises for Rhomboids, Latissimus Dorsi, Biceps & Triceps

PHASE III - Strengthening Phase

Weeks 10 - 12
Exercise
  • Continue PRE's with the above program, (elbow weight to 15 pounds and shoulder weight to 10 pounds)
  • Continue Theraband exercises (increase tension and reps as tolerated)
  • Ball & Net exercises; forward 2-hand pass
  • Eccentric TheraBand Program (increaseing tension and reps as tolerated)
  • Standing Flexion
  • Standing Abduction
  • Standing Supraspinatus empty can lift
  • Standing Internal Rotatiion
  • Standing External Rotation
  • Standing Elbow Flexion
  • Standing Elbow Extension
  • Prone extension
  • Prone horizontal abduction
  • Side-lying external rotation
  • Shoulder Shrugs
  • Progressive push-ups
Weeks 12 - 14
Exercise
  • Continue PRE's with the above program, (increase weight as tolerated)
  • Add Theraband exercises in a diagonal pattern
  • Begin high speed Theraband exercises as tolerated
  • Ball & Net, start overhead 2-hand pass, one hand underarm pass
  • Add sport-specific training exercises

PHASE IV - Return to Activity Phase

Weeks 14 - 18
Exercise
  • Continue all the above (increase weights and resistance as tolerated)
  • Begin to emphasize a gradual return to recreational activities
  • Increase Sport-specific training, may attend light practice sessions
  • Swim Program, crawl, sidestroke

Isokinetic Testing of shoulder Between 18-22 Weeks

Return to full activity at 22 weeks