Patient may progress to each phase as long as all goals met from previous phase. Please notify Dr Borque’s team if patient unable to perform any items specified.
Phase 1 (Weeks 0-6):
Focus is on gentle motion and patient comfort
Sling weeks 0-4 when not doing exercises, then when outside of home or for comfort at 4-6 weeks
ROM: Caution to avoid any aggressive stretching especially in ER, ABD, and Flexion
- Week 0-2: sling at all times unless doing elbow/hand/wrist exercises with arm at side
- Week 2-4: Flexion to 100, ER to 15 in 30 degrees shoulder abduction, IR to 20 in 30 degrees shoulder abduction
- Week 4-6: Flexion and scaption as tolerated, ER to 30 in 30 degrees shoulder abduction, IR to 40 in 30 degrees shoulder abduction
Therapeutic exercise:
- Week 0-2: elbow hand and wrist ROM, ball squeezes
- Week 2-6: Minimal effort isometrics at 0 degrees (ABD, FF, ER), unresisted scapula retractions and shoulder shrugs
Phase 2 (Weeks 6-12):
Focus on gradual progression of ROM while protecting repair
ROM:
- Week 6-8: Advance FF and IR to symmetry as tolerated. ER to 50 with arm at side
- Week 8-10: Can progress ER to symmetry at side and can begin ER at 90 ABD, advancing as tolerated
- Week 10-12: advance to full symmetry in all planes
Therapeutic exercise:
- Weeks 6-8: gradual progression from light bands with resisted rows, ER and IR with arm at side and within motion limits, and begin resisted shoulder extension
- Weeks 8-12: continue gradual progression of the above with no motion restriction with exception of no resisted ER at 90 ABD
- Can begin resisted biceps and triceps
Other Exercises:
- Week 8-10: May begin jogging, light agilities, and lower body strengthening that can be done without using UE’s to stabilize weight (leg press, etc)
- Week 10-12: can begin sprinting and advanced agility work. Can begin lunges holding light dumbells and light kettle bell squats
Criteria to advance to Phase 3:
- 12 weeks post op
- Motion near symmetry (90%+)
- ER/IR strength and endurance test at 80% normal
Phase 3 (weeks 12-24):
ROM:
- Continue to advance to symmetry in all planes
Therapeutic exercise:
- Week 12-14: Continue RTC and scapular stabilization strengthening. Can begin resisted ER at 90 ABD. Multi-level rows.
- Week 14-16: Can begin light dumbbell presses on flat bench.
- Week 16-20: Continue the above as tolerated and can begin light incline dumbbell presses as long as no discomfort.
Throwing:
- Week 20: can begin ITP with physician approval
Other Exercises:
- Week 20: Can initiate light lower body strengthening exercises utilizing UE’s to stabilize weights (barbell squats, etc) as long as no discomfort. May also begin light plyometrics.
Criteria to advance to Phase 4:
- 24 weeks post op
- ER/IR strength and endurance testing 90% normal
- 66% ER/IR strength ratio
Phase 4 (week 24+): Return to play
- Advance all upper and lower body gym strengthening as tolerated
- Continue ROM and stretching exercises
- May begin full plyometrics and continue advanced agility work
- Return to mound work after successful completion of ITP and with physician approval
- Goal for strength and ER/IR endurance testing at >95% normal