REHABILITATION PROTOCOL

PHASE I - The Protection Phase

Weeks 0 - 4

Bracing

  • Wear immobilizer at all times

  • Sleep with pillow behind elbow

Exercise

  • Stretch wrist flexors & extensors (hold for 10 seconds, repeat 10 times)

  • Grip putty or soft-ball & squeeze (frequently throughout day)

Weeks 4 - 6

Bracing

Continue wearing immobilizer/sling at all times, continue pillow behind elbow
May come out of immobilizer for exercises

Exercise

  • Perform all exercises to tolerance (take to point of pain and/or resistance and hold)

  • Continue wrist stretching & gripping exercises

  • Codman Pendulum exercises (bend over & stir the pot with SMALL circles, 2 minutes x 3 per day)

  • Rope & Pulley exercises: Shoulder forward-flexion to 60°, abduction to 45°

  • Begin progressive resistance exercises (PRE) for elbow (1 - 5 pounds)

  • Biceps Curl: (hold for 2 seconds and fully extend arm, increase hold time, and number of reps daily)

  • French Curl: (hold for 2 seconds and slowly lower arm, increase hold time and number of reps daily

  • Wrist Curls, supinated & pronated: (hold for 2 seconds and slowly lower wrist)

  • Begin conditioning program for trunk, lower extremities & cardiovascular system


PHASE II - ROM Phase

Weeks 6 - 8

Bracing

  • Wear sling as needed for comfort

  • May discontinue night bracing

Exercise

  • Continue all the above, increase hold time, # reps.  DO NOT increase weights!!!

  • PROM/AAROM:  Shoulder forward-flexion to 90°, Abduction to 90°,  Int Rot to 45° at 90° shoulder abduction, Shoulder horizontal abduction & adduction to tolerance

  • Supine T-bar exercises (same limits as above)

  • Therband ER & IR at 0° shoulder abduction (hold 2 seconds with slow return to starting point)

  • Aquatherapy:  Twist at 30° abduction,  Bobing

 Weeks 8 - 10

Bracing

  • Discontinue all bracing

Exercise

  • Continue all the above, Perform all exercises to tolerance (take to point of pain and/or resistance and hold),  may increase weight to 10 pounds maximum.

  • PROM/AAROM limits:  FF to 160°, ABD to 120°,  IR/ABD to 90°/90° position,  ER/ABD to 90°/90°

  • Begin Active-supine ROM to tolerance.

  • Begin progressive resistance exercises (PRE) for Shoulder (weight 0 - 5 pounds)

  • Shoulder forward-flexion: (hold all for 2 seconds, increase time and number of reps daily)

  • Shoulder Abduction

  • Supraspinatus empty can lift

  • Prone extension

  • Prone horizontal abduction

  • Side-lying external rotation

  • Shoulder Shrugs

  • Progressive push-ups

  • Continue Conditioning Program, may begin jogging

  • Begin Therband Exercises for Rhomboids, Latissimus Dorsi, Biceps & Triceps


PHASE III - Strengthening Phase

 Weeks 10 - 12

Exercise

  • Continue PRE’s with the above program, (elbow weight to 15 pounds and shoulder weight to 10 pounds)

  • Continue Theraband exercises (increase tension and reps as tolerated)

  • Ball & Net exercises; forward 2-hand pass

  • Eccentric TheraBand Program (increaseing tension and reps as tolerated)

  • Standing Flexion

  • Standing Abduction

  • Standing Supraspinatus empty can lift

  • Standing Internal Rotatiion

  • Standing External Rotation

  • Standing Elbow Flexion

  • Standing Elbow Extension

  • Prone extension

  • Prone horizontal abduction

  • Side-lying external rotation

  • Shoulder Shrugs

  • Progressive push-ups

Weeks 12 - 14

Exercise

  • Continue PRE’s with the above program, (increase weight as tolerated)

  • Add Theraband exercises in a diagonal pattern

  • Begin high speed Theraband exercises as tolerated

  • Ball & Net, start overhead 2-hand pass, one hand underarm pass

  • Add sport-specific training exercises


PHASE IV - Return to Activity Phase

Weeks 14 - 18

Exercise

  • Continue all the above (increase weights and resistance as tolerated)

  • Begin to emphasize a gradual return to recreational activities

  • Increase Sport-specific training, may attend light practice sessions

  • Swim Program, crawl, sidestroke

ISOKINETIC TESTING OF SHOULDER BETWEEN 18-22 WEEKS

RETURN TO FULL ACTIVITY AT 22 WEEKS