Postoperative protocols - SLAP repair

Early phase - protective (0 - 4 weeks)

Goals

  • Protect repair
  • Education patient on procedure and therapeutic progression
  • Regulate pain and control inflammation
  • Initiate ROM and dynamic stabilization
  • Neuromuscular re-education of external rotators and scapulothoracic muscles

0 - 2 weeks

  • Sling x 3 weeks
  • Gripping exercises
  • Elbow/wrist/hand ROM
  • Peldulums
  • PROM to AAROM
  • IR/ER proprioception training
  • Initiate gentle alternating isometrics for IR/ER in 0 deg scapular position
  • Initiate passive flexion 90
  • Initiate scapular mobility

2 - 4 weeks

  • Progress ROM: flexion to 120, ER 35 deg (scapular plane), IR 60 (scap plane)
  • Progress sub-maximal alternating isometrics for IR/ER in scap plane
  • Initiate scap strengthening, manual retraction, resisted band retraction
  • Deltoid isometrics (ant/middle/post)
  • Biceps/triceps strengthening
  • Initiate light bandwork for ER/IR

Intermediate phase (weeks 5 - 8)

Goals - normalize arthrokinematics, gain neuromuscular control, normalize posterior shoulder flexibility

Treatment plan

  • ROM progression: flexion to max, ER 65 (scap plane), full IR
  • Initiate joint mobs, if necessary
  • Initiate posterior capsular stretching
  • Progress strengthening (IR/ER band scap plane, side lying ER, scaption full can, CW/CCW ball against wall, bony blade @neutral or rhythmic stabilization)

Milestones for progression

  • Flexion to 160
  • ER to 65 (scapular plane)
  • Full IR
  • Symmetric posterior capsule mobility
  • Progress isotonic strength with IR/ER in available range

Strengthening Phase (9 - 14 weeks)

Goals - normalize ROM, progression of strength, normalize ST motion & strength, overhead activity without pain

Treatment plan

  • ROM Progression: stretching ER @ 90deg abduction, within 10 deg normal ROM in all planes;
  • progression of scap retractors and stabilizers (prone program LT/MT/Rhmd), LT; scapular depression
  • Progress strengthening - challenging rhythmic stabilization, UBE, Initiate isokinetic IR/ER in scapular pain, Initiate IR/ER @ 90 deg abduction, closed kinetic chain exercise

Milestones for progression

  • Within 10 degrees of full AROM in all planes
  • Isometric strength IR/ER <50 % deficit
  • <30% strength deficits, primary shoulder muscles and scap stabilizers

Advanced Strengthening phase (15 - 24 weeks)

Goals - pain free full ROM, Improve UE endurance, improve dynamic stability

Treatment plan

  • Maintain flexibility
  • Progress strengthening - advance CKC, wall push-ups with/without ball, continue w/ overhead strengthening, continue with ISOK IR/ER strengthening @ 90 deg abduction, advance ISOT strengthening, advance rhythmic stabilization training in various ranges and positions
  • Initiate plyometric strengthening, (chest passes, trunk twists, overhead passes, 90/90 single arm plyo)

c. Milestones for progression - full pain free ROM, strength deficits <20% for IR/ER @ 90deg, <20% throughout


Return to sport ( 4 - 6 months)

Goals - pain free full ROM, normalized strength, return to sport/activity program

Treatment plan

  • Continue ISOK training, continue w/ stability training, advanced plyo training, continue with CKC

Milestons: confidence in shoulder, strength deficits <10%, full pain free ROM, completion of return t o sport program




« Go Back to Options