Shoulder Arthroscopy
Shoulder Protocols
Rotator Cuff Repair
Proximal Long Head of Biceps Tenodesis
Bankart Repair
Rotator Cuff Repair
Full Return Goal: 4 ‐ 6 months
Beginning on the second day after surgery, the sling is removed three times per day for 15 to 20 minutes for gentle elbow, forearm, wrist, and digital range of motion with the arm kept at the side. Pendulum exercises are also begun on the second day after surgery. Patients are instructed not to lift the arm actively away from the body and are to remain non-‐weight lifting to the operative arm. The patient may shower after the dressings are removed (48-‐72 hours). A cold‐flow cuff system (or ice) is used for at least 1 week four times per day. A sling is worn at all times, even during sleep, and is removed only for hygiene and to perform prescribed exercises.
Formal physical therapy is prescribed. Active-‐assisted and active range of motion is begun. This includes pulleys, wand, and supine gravity-‐assisted exercises. Active range of motion is still avoided in positions of impingement. At 10 to 12 weeks after surgery, all motion is allowed, including internal rotation behind the back. The scapular stabilizers are isolated and strengthened. Passive range of motion and terminal capsular stretching of the shoulder is progressed gradually. With improvement in range of motion, the patient may begin weaning from the use of the sling, with a goal of discontinuation at the time of the 3 month post op visit.The arm is to remain on a 5lb weight restriction during this time.
Formal lifting restrictions are slowly discontinued. Rotator cuff and shoulder strengthening is begun. The sling is discontinued. A home program for rotator cuff and scapular stabilizer strengthening is provided. The goal is to equalize active and passive range of motion and gradually progress into regular work and recreational activities as rotator cuff strength and endurance improves. Full return to activity is allowed once full range of motion and strength are evident.
Proximal Long Head of Biceps Tenodesis
Full Return Goal: 3 ‐ 4 months
For patients who have isolated tenodesis of the LHBT, rehabilitation begins the day of surgery. Active wrist and hand range-‐of-‐motion exercises are encouraged. One week postoperatively, the patient starts a supervised physical therapy program with gentle passive range of motion of the shoulder and elbow. A sling is worn on the extremity for approximately 4 weeks.
At 8 weeks, active motion of the shoulder and elbow begins as well as low resistance strengthening. Formal physical therapy is typically not needed more than three months and individuals are placed on a home exercise program focused on continued strengthening and motion. Return to play or unrestricted functional activities may occur as early as 4 months postoperatively.
Bankart Repair
This rehabilitation program’s goal is to return the patient/athlete to activity/sport as quickly and safely as possible. The program is based on muscle physiology, biomechanics, anatomy, and healing response.
- Sling for comfort (1 week)
- May wear immobilizer for sleep (2 weeks)
- Elbow/hand ROM
- Gripping exercises
- Passive ROM and active-assisted ROM (L-bar):
- Flexion to tolerance
- Abduction to tolerance
- Internal rotation in the scapular plane
- No external rotation until week 4
- Submaximal isometrics
- Rhythmic stabilization
- Cold Therapy, modalities as needed
- Gradually progress ROM Flexion to 120-140 degrees
- Internal rotation in the scapular plane to 45-60 degrees
- Initiate external rotation in scapular plane to 15 degrees (week 4)
- Shoulder extension
- Initiate light isotonics for the shoulder musculature
- Tubing for internal rotation
- Dumbell exercises for the deltoid, biceps, and scapular musculature
- Continue dynamic stabilization exercises, PNF
- Initiate self-assisted capsular stretching:
- Progress ROM as tolerated:
- Flexion to 160 degrees (maximum)
- Internal rotation at 90 degrees abduction to 75 degrees
- External rotation at 90 degrees abduction to 0-30 degrees (week 4)
- Shoulder extension to 30-35 degrees
- Joint mobilization, stretching, etc
- Continue self-assisted capsular stretching
- Upper body ergometer with the arm at 90 degrees abduction
- Progress all strengthening exercises
- Continue PNF diagonal patterns (rhythmic stabilization techniques):
- Continue isotonic strengthening
- Dynamic stabilization exercises
- Progress ROM to full
- External rotation at 90 degrees abduction: 45-60 degrees
- Internal rotation at 90 degrees abduction: 70-75 degrees
- Flexion 165-175 degrees
Protocol Disclaimer:
These are to simply be used as guidelines. This information is provided for informational and educational purposes only. Specific treatment of a patient should be based on individual needs and the medical care deemed necessary by the treating physician and therapists. I take no responsibility or assume no liability for improper use of these protocols. Consult your treating physician or therapist for specific courses of treatment.