Phase 1 (Week 0-4):
ROM:
- PROM and AAROM only (see exercises below), Avoid AROM
- Avoid IR/ER beyond neutral
WB: No WB on operative extremity (do not use arm to support body weight)
Sling: Remain in Ultrasling when not doing exercises
Avoid lifting anything with operative extremity
Therapeutic Exercises:
- pendulum swings, scapula retractions, shoulder shrugs
- AROM exercises elbow, wrist, and hand
- Supine shoulder flexion with dowel, advance as tolerated without forcing motion
- Seated/Standing Shoulder Flexion Towel Slide at Tabletop/Counter
Criteria for progression to the next phase:
- Good understanding and compliance with dislocation precautions
- Progressing shoulder AA/PROM
- Good understanding of activity limits and necessary modifications
- Independence with HEP
Phase 2 (Weeks 4-6):
ROM:
- Continue PROM and AAROM only (see exercises below), Avoid AROM
- Do not push IR, very gentle IR only
- Avoid shoulder hyperextension
WB: No WB on operative extremity (do not use arm to support body weight)
Sling: To be worn at night and when outside of home
Lifting: No lifting objects heavier than coffee cup
WB: No WB on operative extremity (do not use arm to support body weight)
Sling: To be worn at night and when outside of home
Lifting: No lifting objects heavier than coffee cup
Therapeutic Exercises:
- Continue above
- AAROM: Active assistive shoulder flexion, shoulder flexion with cane, cane external rotation stretch, seated shoulder elevation with cane
- AROM: supine flexion, salutes
- Deltoid isometrics
Phase 3 (weeks 6-8):
ROM:
- Gradually progress shoulder PROM, AAROM, AROM
- Avoid shoulder hyperextension
WB: No WB on operative extremity (do not use arm to support body weight)
Sling: Discontinue
Lifting: No lifting objects heavier than coffee cup
Therapeutic Exercises:
- Continue above
- PROM: Full in all planes, gradual PROM IR in scapular plane
- AAROM: incline table slides, wall climbs, pulleys, seated shoulder elevation with cane with active lowering
- AROM: seated scaption, seated flexion, supine forward elevation with elastic resistance to 90 deg
Strengthening:
- Periscapular: Row on physioball
- Deltoid: seated shoulder elevation with cane, seated shoulder elevation with cane with active lowering, ball roll on wall Motor control
- IR/ER in scaption plane and Flex 90-125 (rhythmic stabilization) in supine Stretching
- Sidelying horizontal ADD, triceps, and lats
Phase 4 (weeks 8-12): Goal of this phase is return to full functional activities
ROM: Full ROM in all planes
WB: WBAT
Lifting: No lifting objects heavier than 10#
Therapeutic Exercises: Continue above
Strengthening:
- Periscapular: Resistance band shoulder extension, resistance band seated rows, rowing, robbery, lawnmowers, tripod, pointer
- Deltoid: gradually add resistance with deltoid exercise
Motor control:
- IR/ER and Flex 90-125 (rhythmic stabilization)
- Quadruped alternating isometrics and ball stabilization on wall
- Field goals
- PNF – D1 diagonal lifts, PNF – D2 diagonal lifts
Phase 5 (weeks 12+):
ROM: Full ROM in all planes
WB: WBAT
Lifting: No lifting objects heavier than 15# until week 16 then lifting as tolerated
Therapeutic Exercises: Continue above
Strengthening:
- Periscapular: Push-up plus on knees if pain free and easily tolerated, “W” exercise, resistance band Ws, prone shoulder extension, dynamic hug, resistance band dynamic hug, resistance band forward punch, forward punch
- Deltoid: continue gradually increasing resisted flexion and scaption in functional positions
- Elbow: Bicep curl, resistance band bicep curls, and triceps
- Rotator cuff: internal external rotation isometrics, side-lying external rotation, Standing external rotation w/ resistance band, standing internal rotation w/ resistance band, internal rotation, external rotation, sidelying ABD→standing ABD
Motor Control:
- Resistance band PNF pattern, PNF – D1 diagonal lifts w/ resistance, diagonal-up, diagonal-down, wall slides w/ resistance band