ShastaOrtho

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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