Surgical Explanations
Rehabilitation Protocols
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SLAP (Labrum Repair)
Rehabilitation goals following an arthroscopic superior labrum anterior posterior repair are to:
Control post-surgical pain and inflammation
Regain normal active and passive shoulder range of motion
Reestablish upper extremity strength and endurance
Achieve a level of function based on the patient’s goals and the orthopedic and rehabilitation team’s recommendations
Physical therapy within the first week following a SLAP repair is advised to enhance passive shoulder range of motion, which helps to prevent shoulder stiffness and enhance circulation. Therapists will establish a home program, which will change as rehabilitation proceeds. At all times, you will be given recommendations for maintaining general fitness. It is wise that you continue to wear the protective djOrtho Ultra Sling II for several days following surgery. It is also prudent to remove the sling several times a day to allow active and passive mid-range motion.
PHASE 1: WEEK 1-3
During this time, even minimal shoulder motion will provoke discomfort secondary to the arthroscopic portal sites and the area on the glenoid (shoulder socket) rim where the SLAP tear has been repaired. During the first 3 weeks, the goals are therefore to become comfortable with mid-range shoulder motion and activate muscles about the shoulder with physical therapy direction. Oral narcotics may be required during the first week, but the need should then rapidly diminish. As with any shoulder surgery you will find it more comfortable to sleep in a sitting or propped-up position, although no specific sleeping position is prohibited.
EXERCISE GOAL:
1-3 ROM Gradual°
Passive range of motion
Flexion/Elevation 0-60° wk 1
0-75° week 2
0-90° week 3
Passive range of motion-scapular plane
External rotation 0-15° week 1
0-30° week 2-3
Internal rotation as tolerated
Pendulum exercises
Rope/Pulley (flexion, abduction, scaption)
Wand exercises in all planes within limitations
Posterior capsule stretch
Manual stretching and Grade I-II joint mobs
STRENGTH:
Initiate submaximal isometrics
***NO elbow flexion***
Initiate scapular stabilizer strengthening
Initiate UBE without resistance
BRACE (djOrtho Ultra Sling II):
Brace for 3 weeks or as noted by Dr. Bryan
Sling can be removed while performing exercises above
MODALITIES
Electric stimulation as needed
Ice for 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 3-6
During this phase, your shoulder should be quite comfortable with simple tasks such as eating, working on a computer, or even driving a car. It is imperative that you do not allow your shoulder out of mid-range position lest it put strain on the repair. These restrictions are mandatory, and don’t make the mistake of increasing your activity as shoulder comfort allows during this phase.
EXERCISE GOAL:
3-6 ROM Gradual°
Passive range of motion
Flexion/Elevation 0-145°
Passive range of motion-scapular plane
External Rotation 0-50° week 6
Internal Rotation Full ROM week 6
Pendulum exercise
Posterior capsule stretch
Rope/Pulley (flexion, abduction, scaption)
Wand exercise-all planes within limitations
Manual stretching and Grade II-III to reach goals
STRENGTH:
Continue isometric activities as in Phase 1
Initiate supine rhythmic stabilization at 90° flexion
Initiate IR/ER at neutral with tubing
Initiate forward flexion, scaption, empty can
Initiate side-lying ER and triceps strengthening
Push-up progression
Prone abduction with external rotation
Shoulder shrugs with resistance
Supine punches with resistance
Shoulder retraction with resistance
Initiate UBE for endurance
Prone rows
Initiate light biceps curls at week 3
MODALITIES:
Ice 15-20 minutes
GOALS OF PHASE:
Control pain and inflammation
Enhance upper extremity strength
Gradual increase in ROM
PHASE 3: WEEK 6-12
During this third phase, your shoulder will be comfortable performing light tasks and even working overhead. It’s still not time to place undo stress on the repaired SLAP lesion. Physical therapy will closely monitor your progress and provide important dos and don’ts. Physical therapy exercises will expand to include several rotator cuff strengthening measures.
EXERCISE GOAL:
6-12 ROM Full ROM
Continue all ROM activities from Phase 2 10-12 weeks
Posterior capsule stretching
Towel stretching
Rope/Pulley activities
Wand exercises
Manual stretching and Grade III-IV mobs
STRENGTH:
Continue all strengthening from previous phases increasing resistance and repetitions
Initiate plyotoss chest pass
Initiate PNF patterns with Thera-Band®
Initiate IR/ER exercises at 90° abduction
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
It is assumed that SLAP repair is becoming biologically mature; therefore, during the next several weeks the volume of activity will be increased per physical therapy. Physical therapists and athletic trainers will initiate activities simulating your individual sports goals. During week 16 light throwing will proceed to an interval-throwing program. By week 24 you should be discharged from active medical care and given the “green light” to resume sports or full work activities. Always be cognizant of the condition which created your SLAP tear to avoid re-injury. Good luck!
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 an increase in resistance and high-speed repetitions
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, lat pull down
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 and functional training |
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