Phase 1: Immediate postoperative period (weeks 0-6)

  • Precautions
    • Keep your arm in your sling, remove only for motion exercises and therapy.
    • No shoulder active motion, lifting or shoulder motion behind the back.
    • No excessive stretching or sudden movements. Do not support any weight.
    • Keep incision clean and dry. You may shower after your first post-operative visit.
  • Goals
    • Protect the Labral Repair
    • Gradually increase Passive Motion
    • Control pain and inflammation
    • Become independent with modified activities
  • Criteria for Progression to Phase 2
    • Passive forward flexion to > 90°
    • Passive ER to 10°
    • Passive IR to 45°
    • Passive abduction > 90° in the scapular plane
  • Days 1 to 6
    • Wear your sling full time.
    • Pendulum exercises
    • Actively move your fingers, wrist, and elbow
    • Begin scapula musculature isometrics / sets
    • Ice for pain and inflammation
  • Days 3 to 6
    • Begin passive pulley exercises in forward flexion and abduction < 90°
    • Maintain proper posture, joint protection, positioning and hygiene
  • Days 7 to 28
    • Continue with your sling at night and during the day for comfort
    • Wear your sling while out of the house to alert others to your condition
    • Continue Pendulum / pulley exercises
    • Begin Passive ROM to tolerance (done lying down; should be pain free)
      • Flexion to 90°
      • ER in scapular plane to 25-30°
      • IR in scapular plane to 55-60°
      • Continue elbow, wrist, and finger AROM / resisted
    • Submaximal isometrics for all cuff, periscapular, and shoulder musculature
    • Cold therapy as needed for pain control and inflammation
    • May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin three weeks after surgery

Phase 2: Protection and active motion (weeks 6-12)

  • Goals
    • Allow healing of soft tissue
    • Do not overstress healing tissue
    • Gradually restore full Passive ROM by week 6
    • Decrease pain and inflammation
  • Criteria for progression to Phase 3
    • Full AROM
  • Precautions
    • No lifting
    • No supporting body weight with hands and arms
    • No sudden movements
    • Avoid upper extremity bike and ergometer
  • Weeks 6-7
    • Discontinue sling at night
    • Between weeks 4-6, begin to use your sling for comfort only
    • Discontinue sling at end of week 6 as it will inhibit full return of your motion
    • Gradually improve PROM and AROM
      • Flexion and elevation in the plane of the scapula to 145°
      • Abduction to 145°
      • External rotation 45-50° at 45° abduction
      • Internal rotation 55-60° at 45° abduction
      • Extension to tolerance
    • Continue ice as needed
    • May use heat before ROM exercises
    • Aquatherapy OK for light AROM exercises
    • Ice after exercise
  • Weeks 6-8
    • Continue AROM, AAROM, and stretching exercises
    • Begin rotator cuff isometrics – No empty can in forward plane
    • Continue periscapular exercises
    • Gradually progress PROM and AROM
      • Flexion, elevation in the plane of the scapula, and abduction to 180°
      • External rotation 90-95° at 90° abduction
      • Internal rotation 70-75° at 90° abduction
      • Extension to tolerance

Phase 3: Early Strengthening (weeks 10-16)

  • Goals
    • Full Active ROM (weeks 10-16)
    • Maintain full Passive ROM
    • Dynamic shoulder stability
    • Gradual restoration of shoulder strength, power, and endurance
    • Optimize neuromuscular control
    • Gradual return to functional activities
  • Criteria for progression to Phase 4
    • Ability to tolerate progression to the low level functional activities
    • Demonstrated return of strength / dynamic shoulder stability
    • Reestablishment of dynamic shoulder stability
    • Demonstrated adequate strength and dynamic stability for progression to more demanding work- and sport-specific activities
  • Precautions
    • No lifting objects >5 pounds, sudden lifting or pushing activities, sudden jerking motions, overhead lifting
    • Avoid upper extremity bike and ergometer
  • Week 10
    • Continue stretching and PROM, as needed
    • Dynamic stabilization exercises
    • Progress ER PROM and AROM to thrower’s motion
      • ER 110-115 at 90° abduction in throwers (weeks 10-12)
      • Progress shoulder isotonic strengthening exercises as above
      • Continue all stretching exercises as need to maintain ROM.
      • Progress ROM to functional demands (i.e., overhead athlete)
  • Week 12
    • Begin gentle resisted biceps isotonic strengthening @ week 12
  • Week 14
    • Continue all exercises listed above
    • Progress to fundamentals shoulder exercises

Phase 4: Advanced strengthening (weeks 16-22)

  • Goals
    • Maintain full non-painful AROM
    • Advance conditioning exercises for enhanced functional use
    • Improve muscular strength, power and endurance
    • Gradual return to full activities
  • Week 16
    • Continue ROM and self-capsular stretching for ROM maintenance
    • Continue progression of strengthening
    • Advance proprioceptive, neuromuscular activities
    • Light sports (golf chipping / wedges, tennis ground strokes) if doing well
  • Week 20
    • Continue strengthening and stretching
    • Continue stretching if motion is tight
    • Initiate interval sports program (e.g., golf, doubles tennis) if appropriate

AAROM = active assisted range of motion
ADL = activity of daily living
AROM = active range of motion
ER = external rotation
IR = internal rotation
PROM = passive range of motion
ROM = range of motion