Surgical Explanations
Rehabilitation Protocols
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Arthroscopic Bankart
Anterior shoulder instability often leads to surgical repair. Following surgery, the patient, along with the physician and physical therapist’s direction, must carefully monitor ever-increasing activities to avoid placing unnecessary stress on the repaired shoulder.
PHASE 1: WEEK 1-4
Following Arthroscopic Bankart repair, sleeping is always a challenge. You’ll find that sitting in a semi-reclined position or with pillows in your bed makes rest more pleasant. You will be provided with a sling at surgery; this sling is to be worn for comfort only. You are allowed to remove your arm from the sling as needed to exercise your elbow and wrist. Keeping your arm in the sling for too long could impede your progress and possibly lead to additional complications.
It is imperative that physical therapy initiates care soon after surgery. The therapist’s role will evolve as your rehabilitation proceeds. During the first three weeks, the physical therapist’s role is to assist you with mid-range passive range of motion exercises, initiate gentle exercises for the muscles around the shoulder, and provide you with advice for returning to general conditioning.
EXERCISE GOAL:
1-4 ROM Gradual °
Passive and AAROM
Flexion/Elevation 0-120° wk 4
Passive and AAROM-scapular plane
External rotation 0-30° wk 4
Internal rotation as tolerated
Pendulum exercises
Rope/Pulley (flexion, scaption, abduction)
Wand exercises-all planes within limitations
Posterior capsule stretch
Manual stretching and Grade I-II joint mobs
STRENGTH:
Initiate sub-maximal isometrics-PAIN FREE
BRACE (djOrtho Ultra Sling II):
Brace for 4 weeks or as noted by Dr. Bryan
Sling removed for exercises above
MODALITIES:
Electric stimulation as needed
Ice 15-20 minutes
GOALS OF PHASE:
Promote healing of tissue
Control pain and inflammation
Gradual increase in ROM
Independent in HEP
Initiate muscle contraction
PHASE 2: Week 4-8
Plan on regular physical therapy visits during weeks 4-8, as exercises will be added to increase flexibility and assist motion.
EXERCISE GOAL:
4-8 ROM Gradual °
Passive and AAROM
Flexion/Elevation 0-140° wk 6
0-160° wk 8
Passive and AAROM-scapular plane
External rotation 0-75° wk 8
Internal rotation Full ROM wk 8
Pendulum exercises
Posterior capsule stretch
Rope/Pulley (flexion, scaption, abduction)
Wand exercises in all planes within limitations
Manual stretching and Grade II-III joint mobs
STRENGTH:
Continue isometric activities as in Phase 1
Initiate supine rhythmic stabilization at 90° flexion
Initiate UBE for endurance
Initiate plyometric chest pass
Initiate IR/ER at neutral with tubing
Initiate flexion, scaption, empty can
Prone horizontal abduction (100°, 90°) extension
Push-up progression
Initiate side-ling ER, triceps, biceps
Initiate scapular stabilizer strengthening
Concentrate on eccentric activities
BRACE (d/c wk 4):
Discharge brace end of week 4
MODALITIES:
Ice 15-20 minutes
GOALS OF PHASE:
Control pain and inflammation
Enhance upper extremity strength
Gradual increase in ROM
PHASE 3: WEEK 8-12
Your shoulder should now be comfortable with simple tasks. The therapist will allow you to start lifting light objects. During this phase, many shoulder strengthening exercises will begin. The biggest challenge will be to regain functional shoulder external rotation. You will be taught stretching exercises, which should be undertaken with diligence on a daily basis.
EXERCISE GOAL:
8-12 ROM Full ROM
Continue all ROM activities from previous 4-8 week phases
Posterior capsule stretch
Towel stretch
Manual stretching and Grade III-IV joint mobs
STRENGTH:
Continue all strengthening from previous phases
Increasing resistance and repetitions
Initiate overhead plyotoss at week 10-12
Progress with ER at 90° abduction with tubing
UBE for strength and endurance
Progress rhythmic stabilization activities to include standing PNF patterns with tubing
Initiate isokinetic IR/ER at neutral at week 10-12
MODALITIES:
Ice 15-20 minutes
GOALS OF PHASE:
Minimize pain and swelling
Reach full ROM
Improve upper extremity strength and endurance
Enhance neuromuscular control
Normalize arthrokinematics
PHASE 4: WEEK 12-24
During this time the tissue repair has become biologically mature. The exercises will now become more functional. The amount of weight you will be allowed to lift will increase. The amount of weight will be based on your ability to externally rotate and abduct your shoulder. For overhead athletes, a throwing program will begin. Resistive upper body training will be monitored by a physical therapist or athletic trainer with the intent that by week 24 you will be discharged from active care and return to your chosen sport.
WEEK EXERCISE GOAL:
12-24 ROM
Continue with all ROM activities from previous phases
Posterior capsule stretching
Towel stretching
Grade III-IV joint mobs as needed for full ROM
STRENGTH:
Progress strengthening program with increase in resistance and high-speed repetition
Progress with eccentric strengthening of posterior cuff and scapular musculature
Initiate single arm plyotoss
Progress rhythmic stabilization activities to include standing PNF patterns with tubing
UBE for strength and endurance
Initiate military press, bench press, and lat pull-downs
Initiate sport-specific drills and functional activities
Initiate interval throwing program week 16
Initiate light plyometric program week 12-16
Progress isokinetics to 90° of abduction at high speeds
MODALITIES:
Ice 15-20 minutes
GOALS OF PHASE:
Full ROM
Maximize upper extremity strength and endurance
Maximize neuromuscular control
Initiate sports specific training/functional training |
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