SHOULDER: Rehabilitation protocols: protecting the repair Tim Anne, PT Physical Therapist and Owner Lattimore Physical Therapy

What is overall objective for rehab?  Restore structural mobility  Strengthen dynamic stabilizers of glenohumeral and scapulothoracic joints  Address kinetic chain deficits to reduce overall loading onto shoulder (i.e. Core stabilization)

PT’s must monitor patient’s exercise quality for improved efficiency throughout rehab

Common Surgical Procedures seen by PT’s Bankart Repair (Anterior vs. Posterior) SLAP Tears Laterjet Capsular shift

ROM  Strength  Endurance Do not need to wait until patient has full ROM to initiate strengthening Address muscular endurance as gross strength improves

Bankart Procedure

Match the protocol to the patient!

Open vs. Arthroscopic  Open – protect subscapularis by not introducing resisted IR for 6 weeks  Arthroscopic – can begin cuff strengthening much earlier

Bankart Repair Immediate Considerations Sling  2-6 weeks depending on doctor preference  Sleep with sling for up to 6 weeks  Educate on proper sleeping positions Ice  3-5x/day for minutes

Bankart Repair Protocol P/AAROM (0-4 Weeks)  Flexion 0-90 degrees  ER (at 0 deg abd) 0-15 degrees depending on doctor preference  IR to tolerance

Bankart Repair Protocol P/AAROM (4-8 Weeks)  Flexion – progress as tolerated at 6 weeks  ER (at 45 deg abd) progress 5-10 degrees/week  IR slowly progress to full

Bankart Repair Protocol P/AAROM (8-12 Weeks)  All ROM to be progressed to full by week 12  May begin PROM/joint mobs if goals are not met by week 12

Bankart Repair Protocol Therapeutic Exercises (0-4 Weeks)  Putty/Towel Squeeze  Pendulum  Scapular Retractions/Depressions  Shoulder Shrugs At Week 3, initiate:  Isometric ER  Isometric IR (if no open repair)

Bankart Repair Protocol Therapeutic Exercises (6-8 Weeks)  Posterior Capsule Stretch (Crossed Body)  Sleeper Stretch  Posterior Joint Mobilizations  Prone Scapular Exercises Ext/Row/Horiz Abd/Scaption  Sidelying ER/Abd  T-Band Ext/IR/ER to neutral  Standing Flexion/Scaption  Wall Push-Up

-No weight until able to easily perform 30 reps with limb weight OR -When proper scapulohumeral & scapulothoracic timing is achieved

Bankart Repair Protocol Therapeutic Exercises (8-12 Weeks)  Alphabet Stabilization (OKC vs CKC)  PNF Patterns with T-band  Prone W’s  Quadruped Rocking  Push-Up Progressions Wall/Table/Floor  Begin higher level rhythmic stabilizations and proprioceptive training

Bankart Repair Protocol Therapeutic Exercises (3-6 Months)  Aggressive Stretching as needed  Increase load with resistance training (higher reps/lower weight)  DYNAMIC STABILIZATION DRILLS  Initiation of: Plyometrics Throwing program Sports specific program Eccentric loading

Thank you!