Cedars-Sinai Orthopaedics - Santa Monica

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Post-Op Labral Repair Rehabilitation
SLAP Repair

Phase 1: Immediate postoperative period (weeks 0-6)

 

Goals

Maintain / protect the integrity of repair

Gradually increase PROM

Diminish pain and inflammation

Prevent muscular inhibition

Become independent with modified ADLs

 

Precautions

Maintain arm in KnappSak2, remove only for exercise

No shoulder AROM, lifting of objects, shoulder motion behind the back,                                   excessive stretching or sudden movements, supporting of any weight,       lifting a body weight by hands

Keep incision clean and dry

 

Criteria for Progression to Phase 2

Passive forward flexion to > 90°

Passive ER to 10°

Passive IR to 45°

Passive abduction > 90° in the scapular plane

 

Days 1 to 6

KnappSak2

Pendulum exercises

Finger, wrist, and elbow AROM without weights

Begin scapula musculature isometrics / sets; cervical ROM

Cryotherapy for pain and inflammation

Days 3 to 6

            Begin pulley exercises in forward flexion and abduction < 90°

            Maintain proper posture, joint protection, positioning and hygiene

Days 7 to 28

            Continue with KnappSak2 at night and day for comfort

Pendulum / pulley exercises

Begin PROM to tolerance (done supine; should be pain free)

                        Flexion to 90°

ER in scapular plane to 25-30°

IR in scapular plane to 55-60°

Continue elbow, wrist, and finger AROM / resisted

Submaximal isometrics for all cuff, periscapular, and shoulder musculature

Cryotherapy is needed for pain control and inflammation

May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin three weeks postoperative

 

Phase 2: Protection and active motion (weeks 6-12)

 

Goals

Allow healing of soft tissue

Do not overstress healing tissue

Gradually restore full PROM (weeks 4-5)

Decrease pain and inflammation

 

Precautions

No lifting

No supporting body weight with hands and arms

No sudden jerking motions

Avoid upper extremity bike and ergometer

 

Criteria for progression to Phase 3

Full AROM

 

Weeks 5-6

Discontinue KnappSak2 at night

Between weeks 4-6, use KnappSak2 for comfort only

Discontinue KnappSak2 at end of week 6

                  Gradually improve PROM and AROM

                  Flexion and elevation in the plane of the scapula to 145°

                  Abduction to 145°

                  External rotation 45-50° at 45° abduction

                  Internal rotation 55-60° at 45° abduction

                  Extension to tolerance

Continue cryotherapy as needed

May use heat before ROM exercises

Aquatherapy OK for light AROM exercises

Ice after exercise

Weeks 6-8

Continue AROM, AAROM, and stretching exercises

Begin rotator cuff isometrics – No empty can in forward plane

Continue periscapular exercises

                 

           Gradually progress PROM and AROM

                        Flexion, elevation in the plane of the scapula, and abduction to 180°

                        External rotation 90-95° at 90° abduction

      Internal rotation 70-75° at 90° abduction

      Extension to tolerance

 

AAROM = active assisted range of motion

ADL = activity of daily living

AROM = active range of motion

ER = external rotation

IR = internal rotation

PROM = passive range of motion

ROM = range of motion

 

Phase 3: Early strengthening (weeks 10-16)

 

Goals

Full AROM (weeks 10-16)

Maintain full PROM

Dynamic shoulder stability

Gradual restoration of shoulder strength, power, and endurance

Optimize neuromuscular control

Gradual return to functional activities

 

Precautions

No lifting objects >5 pounds, sudden lifting or pushing activities, sudden                                  jerking motions, overhead lifting

Avoid upper extremity bike and ergometer

 

Criteria for progression to Phase 4

Ability to tolerate progression to the low level functional activities

Demonstrated return of strength / dynamic shoulder stability

Reestablishment of dynamic shoulder stability

Demonstrated adequate strength and dynamic stability for progression to                               more demanding work- and sport-specific activities

 

Week 10

Continue stretching and PROM, as needed

Dynamic stabilization exercises

                  Progress ER PROM and AROM to thrower's motion

                  ER 110-115 at 90° abduction  in throwers (weeks 10-12)

                  Progress shoulder isotonic strengthening exercises as above

                  Continue all stretching exercises as need to maintain ROM.

                  Progress ROM to functional demands (i.e., overhead athlete)

                 

 

Week 12

Begin gentle resisted biceps isotonic strengthening @ week 12

 

Week 14

Continue all exercises listed above

Progress to fundamentals shoulder exercises

 

Phase 4: Advanced strengthening (weeks 16-22)

 

Goals

Maintain full non-painful AROM

Advance conditioning exercises for enhanced functional use

Improve muscular strength, power and endurance

Gradual return to full activities

 

Week 16

Continue ROM and self-capsular stretching for ROM maintenance

Continue progression of strengthening

Advance proprioceptive, neuromuscular activities

Light sports (golf chipping / wedges, tennis ground strokes) if doing well

 

Week 20

Continue strengthening and stretching

Continue stretching if motion is tight

Initiate interval sports program (e.g., golf, doubles tennis) if appropriate


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