Rehabilitation Guidelines for Arthroscopic Anterior Stabilization

Post-Operative Rehabilitation Guidelines for Arthroscopic Anterior Stabilization

0-4 Weeks:

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

4-8 Weeks:

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

8-12 Weeks:

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

3-12 Months:

STRENGTHENING PHASE

• 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.

1. Begin isokinetics.
   1. Begin muscle endurance activities (UBE).
   2. High seat and low resistance
2. Must be able to do active shoulder flexion to 90 degrees without substitution
3. Continue with agility exercises.
4. Advanced functional exercises.
5. Isokinetic test.
6. Functional test assessment.
7. Full return to sporting activities.