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

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Phase 1

Sling

1. Full time use for 6 weeks
2. Sleep in sling until after week 6
3. Discontinue after week 6

Weeks 0-6

1. Passive motion only beginning first post-operative day
   • Forward elevation (Goal ≥ 140° ASAP)
   • External rotation (Goal ≥ 40° ASAP)
     • ** Hold at 40° if labral repair was also done **
   • Extension not beyond 0°
   • No internal rotation until week 7
2. Hand/wrist/elbow AROM, NO RESISTANCE
3. Scapular stabilization exercises (Shrugs, Retraction, Protraction)
4. Home exercise program
   • Passive External rotation with caregiver
5. NO pulleys, pool therapy, or electric stimulation until after week 6

Phase 2

Weeks 7-12

1. Continue passive motion as needed until full range of motion, then start AAROM and advance to full AROM
2. Continue Scapular Stability exercises
3. Add passive internal rotation
4. Home exercise program
   • Add wall climb, self-controlled active assisted elevation, supine wandexercises

Phase 3

Week 12+

1. Begin strengthening upon approval
   • Low Level therabands/tubes: FE, IR, ER, Rows
2. Transition to Independent Home Exercise Program
   • Stretching Daily
   • Strength 3x/wk max

Month 6

1. Return to full activity

Specific Needs

1. Biceps tenodesis
   • – Elbow slight active motion only first 6 weeks (no resistance/repetitive use)
   • Avoid terminal extension of elbow first 6 weeks
   • Gradual Biceps strengthening after 12 weeks
2. Labral repair
   • Limit external rotation to 40° and Forward Elevation to 140° for first 6 weeks