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Phase I – Immediate Post Surgical Phase (Day 1-14):
Goals:

• Restore non-painful range of motion (ROM)
• Prevent muscular atrophy and inhibition
• Decrease pain/inflammation
• Improve postural awareness
• Minimize stress to healing structures
• Independent with activities of daily living (ADLs)
• Wean from sling

Precautions:

• Care should be taken with abduction (with both active range of motion (AROM) and
passive
range of motion (PROM) to avoid unnecessary compression of subacromial structures
• Creating or reinforcing poor movement patterns, such as excessive scapulothoracic
motion with
upper extremity elevation, should be avoided

Range of Motion:

• PROM (non-forceful flexion and abduction)
• Active assisted range of motion (AAROM)1
• AROM
• Pendulums
• Pulleys
• Cane exercises
• Self stretches, including posterior capsule, upper trapezius, and pectoralis major
Strengthening:
• Isometrics: scapular musculature, deltoid, and rotator cuff as appropriate
• Isotonic: theraband internal and external rotation in 0 degrees abduction
Modalities2:
• Cryotherapy
• Electrical stimulation and/or inferential current to decrease swelling and pain (as
indicated
and/or needed)

Criteria for progression to phase 2:

• Full active and passive ROM
• Minimal pain and tenderness

Phase 2: Intermediate Phase (2-6 Weeks)
Goals:

• Regain and improve muscular strength
• Normalize arthrokinematics
• Improve neuromuscular control of shoulder complex
• Continue to wean from sling if applicable

Precautions1:

• Overhead activities
• Heavy lifting

Exercises:

• Initiate isotonic program with dumbbells
• Strengthen shoulder musculature- isometric, isotonic, Proprioceptive Neuromuscular
Facilitation (PNF)
• Strengthen scapulothoracic musculature- isometric, isotonic, PNF
• Initiate upper extremity endurance exercises

Manual Treatment:

• Joint mobilization to improve/restore arthrokinematics if indicated
• Joint mobilization for pain modulation

Modalities:

• Cryotherapy
• Electrical stimulation - interferential current to decrease swelling and pain (as indicated
and/or
needed)

Criteria for Progression to Phase 3:

• Full painless ROM
• No pain or tenderness on examination

Phase 3: Dynamic (Advanced) Strengthening Phase: (6 weeks and beyond)
Goals:

• Improve strength, power, and endurance
• Improve neuromuscular control
• Prepare athlete to begin to throw, and perform similar overhead activities or other sport
specific
activities

Emphasis of Phase 3:

• High speed, high energy strengthening exercises
• Eccentric exercises3
• Diagonal patterns
• Workplace ergonomic assessment and/or work hardening program referral as needed 1

Exercises:

• Continue dumbbell strengthening (rotator cuff and deltoid)
• Progress theraband exercises to 90/90 position for internal rotation and external
rotation
(slow/fast sets)
• Theraband exercises for scapulothoracic musculature and biceps
• Plyometrics for rotator cuff
• PNF diagonal patterns
• Isokinetics
• Continue endurance exercises

Criteria for discharge from skilled therapy

• Patient able to maintain non-painful AROM
• Maximized functional use of upper extremity
• Maximized muscular strength, power, and endurance
• Patient has returned to advanced functional activities

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