Laterjet Open Anterior Shoulder Stabilization

Phase I MAXIMAL PROTECTION (0-4 Weeks Post-Op)

• Immobilization for 4 weeks using sling.
• Elbow A/AAROM: flexion and extension.
• Protect anterior and posterior capsule from stretch, but begin passive ROM
• Limit FE (supine forward elevation in the scapular plane) to 90 degrees
• Limit ER (external rotation) to neutral 30 degrees
• Do Not perform Pendulums.
• Modalities (i.e. CryoCuff) PRN(as needed).
• Wrist and gripping exercises.
• Begin Deltoid/Cuff isometrics
• Removal of sling for showering: maintain arm in sling position.

Phase II MODERATE PROTECTION (4-6 Weeks Post-Op)

• A/AAROM Limit FE (forward elevation in the scapular plane) to 140 degrees
• A/AAROM Limit ER (external rotation) to 45 degrees
• Progress from AAROM to AROM:
• Quality movement only-avoid forcing active motion with substitution patterns.
• Remember the effects of gravity on the limb, do gravity eliminated motions first i.e. Supine elevation in the scapular plane.
• Deltoid isometrics
• Elbow AROM
• Continue with wrist exercises
• Modalities PRN.
• Discontinue sling at 4-6 weeks.

Phase III MINIMAL PROTECTION / MILD STRENGTHENING (6-12 Weeks Post-OP)

• A/AAROM No Limit FE (forward elevation in the scapular plane)
• A/AAROM No Limit ER (external rotation)
• 10-12 weeks, AIAA/PROM to improve ER with arm in 45 degree abduction.
• AROM all directions below horizontal, light resisted motions in all planes.
• AROM activities to restore flexion, IR, horizontal ADD as tolerated.
• Deltoid, Rotator Cuff isometrics progressing to isotonic.
• PRE’s for scapular muscles, latissimus, biceps, triceps.
• PRE’s work rotators in isolation (use modified neutral).
• Emphasize posterior cuff, latissimus, and scapular muscle strengthening, stressing eccentrics.
• Utilize exercise arcs that protect anterior and posterior capsule from stress during PRE’s.
• Keep all strength exercises below the horizontal plane in this phase.

Phase IV STRENGTHENING (12-16 Weeks Post-Op)

CRITERIA:

1. Pain-free AROM
2. Pain-free with manual muscle test
3. Progress by response to treatment

• AROM activities to restore full ROM.
• Restore scapulohumeral rhythm.
• Joint mobilization.
• Aggressive scapular stabilization and eccentric strengthening program.
• Initiate isotonic shoulder strengthening exercises including: side lying ER, prone arm raises at 0, 90, 120 degrees, elevation in the plane of the scapula with IR and ER, lat pulldown close grip, and prone ER.
• Dynamic stabilization WB and NWB.
• PRE’s for all upper quarter musculature (begin to integrate upper extremity patterns). Continue to emphasize eccentrics and glenohumeral stabilization.

All PRE’s are below the horizontal plane for non-throwers.

1. Begin isokinetics.
2. Begin muscle endurance activities (UBE).
3. High seat and low resistance
4. Must be able to do active shoulder flexion to 90 degrees without substitution
5. Continue with agility exercises.
6. Advanced functional exercises.
7. Isokinetic test.
8. Functional test assessment.
9. Full return to sporting activities.