Post-op Days 1-14

• Shoulder Immobilizer x6 weeks – Even while sleeping
  • Place pillow under shoulder / arm while sleeping for comfort
• Hand squeezing exercises
• Elbow and wrist active motion (AROM) with shoulder in neutral position at side
• Stationary bike (must wear immobilizer)

Goals

• Pain control
• Protection

Weeks 2 – 4

• Continue immobilizer x6 weeks
• Continue appropriate previous exercises
• Supported pendulum exercises
• Resisted elbow / wrist exercises with light dumbbell (<5#), shoulder in neutral

Goals

• Pain control
• Protection

Weeks 4 – 6

• Continue immobilizer x6 weeks
• Continue appropriate previous exercises
• Shoulder shrugs, scapular retraction without resistance
• Active assisted motion (AAROM) supine with wand – Flexion to 90 degrees
• 1-2 Finger Isometrics x6 (fist in box)

Goal

• Supine AAROM Flexion to 90 degrees

Weeks 6 – 8

• D/C immobilizer
• Continue appropriate previous exercises
• AROM in pain-free range as tolerated, No PROM
• AAROM (pulleys, supine wand, wall climb)
  • Flexion > 90 degrees
  • Abduction and ER to tolerance
  • IR and extension (wand behind back)
• Submaximal isometrics (continue 1-2 fingers for IR)
• Elliptical trainer – Lower extremity only
• Treadmill – Walking progression program

Goal

• AROM Flexion to 120 degrees, abduction to 90 degrees

Weeks 8 – 12

• Continue appropriate previous exercises
• AROM, AAROM through full range, No PROM
• Light Theraband ex – ER, Abduction, Extension
• Biceps and Triceps PREs
• Prone scapular retraction exercises (without weights)
• Push-up plus on wall – no elbow flexion > 90 degrees
• Body blade
• BAPS on hands
• Ball on wall (arcs, alphabet)
• Elliptical trainer (upper and lower extremities)
• Pool walking / running – No UE resistive exercises

Goals

• Full AROM
• 30 wall push-ups

Months 3 – 4

• Continue appropriate previous exercises
• PROM / mobilization as needed to regain full ROM
• Light Theraband ex – IR, Adduction, Flexion, Scaption
  • Continue ER, Abduction, Extension with increased resistance
• Push-up progression – Wall to table to chair (no elbow flexion > 90 degrees)
• Weight training with VERY LIGHT resistance (no flies or pull downs)
  • No elbow flexion > 90 degrees
  • Bench press
  • Seated row weight machine
  • Cable column
• Ball toss with arm at side using light ball
• UBE forwards and backwards a low resistance
• Stairmaster
• Treadmill – Running progression program
• Pool walking / running – With UE resistance (no swimming)

Goals

• 30 table push-ups
• Run 2 miles at easy pace

Months 4 – 6

• Continue appropriate previous exercises with increased resistance
• Fitter on hands
• Ball toss overhead
• Push-up progression – Chair to regular
• Sit-ups
• Weight training with increasing resistance
  • No elbow flexion > 90 degrees
  • Military press, lat pull downs, flies
  • Gravitron for pull-ups and dips
• Swimming
• Running progression to track
• Transition to home / gym program

Goals

• Normal Pectoralis Major strength
• Resume all activities

*NO CONTACT SPORTS UNTIL AFTER 6 MONTHS POST-OP*eeks