Michael Metcalf, M.D. / M. Daniel Hatch, M.D.

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Phase 1

Sling

1. Full time use for first 6 weeks while awake
2. May be out of sling for hygiene and range of motion exercises
3. Discontinue as tolerated after week 6

Weeks 0-6

1. Hand, wrist and forearm active motion
2. Active scapular motion (shrugs, retraction)
3. PASSIVE shoulder motion in all planes
4. NO RESISTANCE INCLUDING BICEPS
5. Independent HEP: PROM: ER with caregiver, shrugs, scapular retraction

Phase 2

Weeks 7-12

1. Begin active assisted shoulder motion in all planes – (NO internal rotation up the back)
2. Home exercise program: AAROM – AROM all planes 2-3 times daily
3. Continue facilitating scapular stability
4. Home exercise program: AAROM – AROM: wand exercise for external rotation, wall climbs, table slides.

Weeks 10-12

1. Advance to full active motion (all planes)
2. Continue facilitating scapular stability
3. Gentle resistance below 90° (all planes)
4. Add upper body ergometer

Phase 3

Week 13+

1. Continue motion as needed
2. Progress to resistance with activities above shoulder level
3. Maintain proper scapulohumeral rhythm
4. Emphasize continued independent home stretching
5. Transition to independent HEP
6. Advance activity as tolerated
7. Maintenance Program
   — Daily Stretching (all planes)
   — Strengthening 2-3 times / week