No combined full abduction with external rotation for 12 weeks. Avoid sharp pain throughout.
Weeks 0 – 3
- Keep sling on at all times except for washing and dressing.
- Active wrist flexion/extension.
- Active elbow flexion/extension – except in the case of SLAP/biceps repair, in which case passive elbow flexion/extension only until 6 weeks.
- Forearm supination/pronation – except in the case of SLAP/biceps repair, in which case passive forearm supination/pronation only until 4 weeks.
Weeks 4 – 6
- Scapulothoracic exercises to address any underlying scapula dyskinesis.
- Pendulum exercises.
- Active assisted flexion to 90 degrees.
- Passive flexion as far as comfortable into range.
- Active assisted abduction to 60 degrees.
- External rotation to neutral only
- Isometric rotator cuff with arm by side in neutral.
Weeks 6 – 12
- Gradually wean off sling during the day, continue to wear at night.
- Gradually increase to full active ROM except for external rotation which should be 80% of the range of the contralateral side. External rotation should be progressed gently and with care.
- Strengthen rotator cuff through range.
- Proprioceptive exercises in NWB.
- Should aim to achieve FULL ROM, gaining last 20 degrees of external rotation.
- Functional/sports specific training.
- Driving – 8 weeks.
- Swimming – breaststroke – 8 weeks.
- Golf – 3 months.
- No contact sports for 6 months.