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

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Phase 1

Sling

1. Sling use for comfort
2. May be out of sling for hygiene and range of motion exercises
3. Discontinue as tolerated after week 6

Weeks 0-6

1. Begin active assisted shoulder motion (all planes except IR)
   **(No active internal rotation until week 7)**
2. Limit external rotation to 40 degrees
3. NO RESISTANCE INCLUDING BICEPS
4. Hand, wrist & forearm active motion
5. Initiate independent home motion with caregiver: PROM
   — external rotation to 40 degrees
6. Active scapular motion (shrugs, retraction, depression)

Phase 2

Weeks 7-12

1. Advance to full active motion (all planes)
   Independent HEP program: daily stretching
2. Scapular stability
3. Maintain proper scapulohumeral rhythm
4. Begin resistance with activities below shoulder level
5. Emphasize continued independent home stretching

Phase 3

Week 13+

1. Return to regular activity
2. Progress resistance with activities above shoulder level
3. Maintenance Program
   — Daily Stretching (all planes)
   — Strengthening 2-3 times / week

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