Michael Metcalf, M.D. / M. Daniel Hatch, M.D.
Phase 1
Sling
- Full time sling use for first 6 weeks while awake
- May be out of sling for hygiene and range of motion exercises
- Discontinue as tolerated after week 6
Weeks 0-6
- Begin Continuous Passive Motion (CPM) Machine in both planes
- Begin with 5-10 min warm-up 5 degrees below prior days progress
- Advance to prior days progress for 15-30 minutes
- Gradually increase 1-2 degrees as tolerated every 20-30 minutes
- External Rotation (ROT) – begin at 20 degrees and increase 5 degrees/week to a maximum of 50 degrees at 6 weeks.
- Elevation (ELE) – begin at 60 degrees and increase 10-15 degree/week to a maximum of 140 degrees at 6 weeks.
- Use the CPM daily for a total of 4-6 hours/day
- Hand, wrist and forearm active motion
- Active scapular motion (shrugs, retraction, depression)
- NO RESISTANCE INCLUDING BICEPS
Phase 2
Weeks 7-12
- Advance to full active motion (all planes)
- Independent HEP program: daily stretching
- Scapular stability
- Maintain proper scapulohumeral rhythm
- Begin resistance with activities below shoulder level
- Emphasize continued independent home stretching
Phase 3
Week 13+
- Return to regular activity
- Progress resistance with activities above shoulder level
- Maintenance Program
— Daily Stretching (all planes)
— Strengthening 2-3 times / week
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