Rehabilitation following Shoulder Stabilisation
It is important to follow operation details and post operative instructions from your surgeon.
Summary of key milestones
Dressings and stitches removed 10 - 14 days post op
Sling for up to 4 weeks
Driving approx. 6 weeks
Passive range of flexion at least 50% of pre-operative level around 4 weeks
Passive range of motion equal to pre-operative level and active range of motion at least 50% of pre-operative level at 8 weeks
Active range of motion equal to pre-operative level at 3 months
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Phase I (Week 0 – 3)
Goals
Pain well controlled
Protect repair
Wound healing well and stitches coming out at 2 weeks
Maintain elbow, neck and wrist movements
Maintain lower limb strength
Restrictions
No passive abduction
No external rotation
Interventions
Maintain good under-arm hygiene while in the sling
Take your painkillers regularly and use ICE to assist with pain and swelling
Elbow, Neck & Wrist ROM - Range of Motion exercises
Patient education on rehabilitation and managing expectations
Scapula setting in sitting
Ensure appropriate removal of sling/ brace as well as appropriate resting positions
Ensure appropriate follow up appointments are made
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Phase II (Week 3 – 6)
Goals
Wean out of the sling from week 3
Maintain adequate pain relief
Improve scar mobility
Return to light work / school as pain &range allows
Postural awareness
Regaining active range of movement – flexion, extension
Adequate scapula control
Functional activities at waist height
Driving
Interventions
Scar massage (if necessary)
Passive & active assisted shoulder flexion. Progress to active shoulder flexion as comfort allows.
Scapula stability work – eg. Weight bearing 4 pt kneeling once range (ie >90) achieved
Isometric cuff work in neutral position (pain free and scapula stable)
Maintain lower body strength
Core stability work incorporating lower Limbs
Restrictions
No passive external rotation beyond 20°
No passive or active combined abduction & external rotation
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Phase III (Week 6 – 12)
Goal
Minimal Pain
Increase ROM
Increase cuff activation
Postural control optimal movement patterning
Good muscle control of active range of movement
Interventions
Continue to work on range as necessary, including abduction (be aware of precautions in introduction)
Progress cuff activity – isometric, to isometric at different ranges, moving to isotonic exercises as comfortable
Progress scapula muscle activity -
Proprioception exercises – eyes open/closed, drop & catch
Normal movement patterning as range returns
Core stability work
Restrictions
No passive external rotation beyond 20°
No passive combined abduction & external rotation up until week 8 -12 eg. no wide arm press-ups, passive stretches
No exercise or activity that increases marked pain or causes apprehension
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Phase IV (3 – 6months)
Goals
Confident function
Regain full range of movement, including abduction and external rotation (if able without apprehension)
Progressively improve control in previously apprehensive positions
Improve power/ endurance of operated shoulder
Good dynamic proprioception
A fully rehabilitated shoulder for noncontact functional demands
Long-term maintenance programme established
Interventions
Active control > passive stretches in abduction & external rotation as possible
Stretches/ Mobilisations if passive range is stiff still (discuss with senior staff if unsure)
Progress resistance through range
Press ups if good shoulder control
Overhead stability work (eg. perturbation training)
Introduce Plyometric exercises when range, strength & control allow
Sport specific fitness & agility exercises
Restrictions
External Rotation – ER should remain tighter on the operated side approx. 90% Range of Motion - ROM of contralateral side
Do not encourage passive stretches of abduction and external rotation if any anterior apprehension symptoms/signs
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