Michael Metcalf, M.D. / M. Daniel Hatch, M.D.

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Phase 1

Sling

1. Full time sling use for first 6 weeks while awake
2. May be out of sling for hygiene and range of motion exercises
3. Discontinue as tolerated after week 6

Weeks 0-6

1. Begin Continuous Passive Motion (CPM) Machine in both planes
   1. Begin with 5-10 min warm-up 5 degrees below prior days progress
   2. Advance to prior days progress for 15-30 minutes
   3. Gradually increase 1-2 degrees as tolerated every 20-30 minutes
   4. External Rotation (ROT) – begin at 20 degrees and increase 5 degrees/week to a maximum of 50 degrees at 6 weeks.
   5. Elevation (ELE) – begin at 60 degrees and increase 10-15 degree/week to a maximum of 140 degrees at 6 weeks.
   6. Use the CPM daily for a total of 4-6 hours/day
2. Hand, wrist and forearm active motion
3. Active scapular motion (shrugs, retraction, depression)
4. NO RESISTANCE INCLUDING BICEPS

Phase 2

Weeks 7-12

1. Advance to full active motion (all planes)
   1. Independent HEP program: daily stretching
2. Scapular stability
3. Maintain proper scapulohumeral rhythm
4. Begin resistance with activities below shoulder level
5. Emphasize continued independent home stretching

Phase 3

Week 13+

1. Return to regular activity
2. Progress resistance with activities above shoulder level
3. Maintenance Program
   — Daily Stretching (all planes)
   — Strengthening 2-3 times / week

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