(Medium sized tear, will adjust protocol for small or large tears)
If possible it is better for the patient if they have been seen in therapy preoperatively to work on increasing PROM, and isometric strengthening. The patient is able to understand exercises better and enhances proprioception for better performance of exercises post-operatively. It also helps to decrease anxiety regarding therapy after surgery.
2 days to 1 week post-op: Patient wears a sling when not exercising for a 2-3 week period post-op. PROM is initiated to shoulder except extension. Passive IR and ER are performed in a scapular plane. Pendulum exercises are initiated and patient is instructed to perform pendulums every 1-2hrs during the day. Scapular elevation, depression, retraction and protraction are initiated and performed every 1-2 hours during the day.
1 week post-op: AAROM is added to ER and IR in a scapular plane, elbow AROM is initiated and hand grippers are added to exercise program.
2 – 4 weeks post-op: P/AAROM is continued to shoulder. Passive IR and ER can now be performed with shoulder at 90 degrees Abduction. Initiate AAROM shoulder flexion with assistance of ropes/pulleys. Pendulum exercises are continued. Rhythmic stabilization drills may be started with patient supine and shoulder at 100 degrees of flexion and 20 degrees horizontal abduction in flexion and extension and for IR and ER in a scapular plane. Isometrics for shoulder flexion, extension, abduction, ER/IR and elbow flexion are performed with elbow flexed and IR and ER in a scapular plane. Gradual progression in muscle strengthening is initiated with light resistance for IR and ER, and scapular muscle strengthening.
4-6 weeks post-op: P/AAROM are continued, AROM is initiated. Continued Rhythmic stabilization drills progressing from supine to side-lying to patient seated. Strengthening is progressed with ER/IR at side, scapular strengthening (prone rowing), and deltoid strengthening.
6-8 weeks post-op: Exercises are continued with gradual progression. Manual resistance, isotonics, eccentrics and endurance exercises are emphasized. Stabilization exercises are performed against a wall, wall push-ups, etc.
12-18 weeks post-op: Exercises continue for ROM and stretching, strengthening and endurance exercises are progressed.
