Phase 1: Protective Phase (Weeks 0-8)

Goals:

• Protect integrity of the repair
• Decrease pain and inflammation
• Gradually increase in ROM
• Retard muscle atrophy

Early Protective Phase (0-6 Weeks)

• Pendulums
• Scapular Isometrics (primary retraction)
• Elbow, Wrist, Hand AROM
• PROM to tolerance
• Modalities as needed

Late Protective Phase (6-8 Weeks)

• Continue previous exercises
• Initiate AAROM exercises progressing to AROM as tolerated
• Shoulder Sub-Maximal Isometrics
• PROM to tolerance
• Modalities as needed

(Patient must be able to elevate arm without shoulder and scapular hiking before initiating standing AROM; if unable, continue with supine exercises).

Phase 2: Early Strengthening Phase (Weeks 8-10)

Goals:

• Decrease pain and inflammation
• Restore full PROM and AROM
• Gradual increase in strength

Early Strengthening Phase

• Continue PROM as needed to achieve and maintain full ROM
• Initiate rhythmic stabilization exercises
• Strengthening exercises for the hand, wrist, elbow and scapular musculature
• Initiate gentle strengthening
• Modalities as needed

Expectations:

• 10-12 weeks – Patient should have achieved full active and passive ROM
• 12-16 weeks – Patient should be nearing normal strength and full ROM

Early Advanced Strengthening Phase (Weeks 10-12)

• Continue exercises above
• Advance strengthening exercises including empty can as tolerated
• General conditioning program

Late Advanced Strengthening Phase (Weeks 12-Discharge)

• Continue all strengthening exercises
• Continue all flexibility exercises
• Gradual progression of functional activities per patient needs