PHASE I - The Protection Phase

Weeks 0 - 4

Bracing

• Wear immobilizer at all times

• Sleep with pillow behind elbow

Exercise

• Stretch wrist flexors & extensors (hold for 10 seconds, repeat 10 times)

• Grip putty or soft-ball & squeeze (frequently throughout day)

Weeks 4 - 6

Bracing

Continue wearing immobilizer/sling at all times, continue pillow behind elbow
May come out of immobilizer for exercises

Exercise

• Perform all exercises to tolerance (take to point of pain and/or resistance and hold)

• Continue wrist stretching & gripping exercises

• Codman Pendulum exercises (bend over & stir the pot with SMALL circles, 2 minutes x 3 per day)

• Rope & Pulley exercises: Shoulder forward-flexion to 60°, abduction to 45°

• Begin progressive resistance exercises (PRE) for elbow (1 - 5 pounds)

• Biceps Curl: (hold for 2 seconds and fully extend arm, increase hold time, and number of reps daily)

• French Curl: (hold for 2 seconds and slowly lower arm, increase hold time and number of reps daily

• Wrist Curls, supinated & pronated: (hold for 2 seconds and slowly lower wrist)

• Begin conditioning program for trunk, lower extremities & cardiovascular system

PHASE II - ROM Phase

Weeks 6 - 8

Bracing

• Wear sling as needed for comfort

• May discontinue night bracing

Exercise

• Continue all the above, increase hold time, # reps.  DO NOT increase weights!!!

• PROM/AAROM:  Shoulder forward-flexion to 90°, Abduction to 90°,  Int Rot to 45° at 90° shoulder abduction, Shoulder horizontal abduction & adduction to tolerance

• Supine T-bar exercises (same limits as above)

• Therband ER & IR at 0° shoulder abduction (hold 2 seconds with slow return to starting point)

• Aquatherapy:  Twist at 30° abduction,  Bobing

 Weeks 8 - 10

Bracing

• Discontinue all bracing

Exercise

• Continue all the above, Perform all exercises to tolerance (take to point of pain and/or resistance and hold),  may increase weight to 10 pounds maximum.

• PROM/AAROM limits:  FF to 160°, ABD to 120°,  IR/ABD to 90°/90° position,  ER/ABD to 90°/90°

• Begin Active-supine ROM to tolerance.

• Begin progressive resistance exercises (PRE) for Shoulder (weight 0 - 5 pounds)

• Shoulder forward-flexion: (hold all for 2 seconds, increase time and number of reps daily)

• Shoulder Abduction

• Supraspinatus empty can lift

• Prone extension

• Prone horizontal abduction

• Side-lying external rotation

• Shoulder Shrugs

• Progressive push-ups

• Continue Conditioning Program, may begin jogging

• Begin Therband Exercises for Rhomboids, Latissimus Dorsi, Biceps & Triceps

PHASE III - Strengthening Phase

 Weeks 10 - 12

Exercise

• Continue PRE’s with the above program, (elbow weight to 15 pounds and shoulder weight to 10 pounds)

• Continue Theraband exercises (increase tension and reps as tolerated)

• Ball & Net exercises; forward 2-hand pass

• Eccentric TheraBand Program (increaseing tension and reps as tolerated)

• Standing Flexion

• Standing Abduction

• Standing Supraspinatus empty can lift

• Standing Internal Rotatiion

• Standing External Rotation

• Standing Elbow Flexion

• Standing Elbow Extension

• Prone extension

• Prone horizontal abduction

• Side-lying external rotation

• Shoulder Shrugs

• Progressive push-ups

Weeks 12 - 14

Exercise

• Continue PRE’s with the above program, (increase weight as tolerated)

• Add Theraband exercises in a diagonal pattern

• Begin high speed Theraband exercises as tolerated

• Ball & Net, start overhead 2-hand pass, one hand underarm pass

• Add sport-specific training exercises

PHASE IV - Return to Activity Phase

Weeks 14 - 18

Exercise

• Continue all the above (increase weights and resistance as tolerated)

• Begin to emphasize a gradual return to recreational activities

• Increase Sport-specific training, may attend light practice sessions

• Swim Program, crawl, sidestroke

ISOKINETIC TESTING OF SHOULDER BETWEEN 18-22 WEEKS

RETURN TO FULL ACTIVITY AT 22 WEEKS