Anterior Stabilisation (open or arthroscopic +/- Bankart repair)
Sling 4-6 weeks. Washing techniques and sling advice/management.
Day 1 on ward – scapula setting in neutral elbow, wrist and hand exercises.
Follow operation post-op instructions – usually to commence active-assisted elevation in neutral to 90° - external rotation to neutral only.
NB. No isometric medial rotation and anterior deltoid for 2 weeks. Can start external rotation in neutral 30 % Maximal Voluntary Contraction.
Can commence active external rotation from day 1 post-op if pain and muscle control allows to neutral for 2/52. No passive mobilisation into E.R. until 6/52.
Review by clinical specialist at 2/52 post-op in clinical specialist shoulder clinic at RSH, to be booked before discharged by ward staff.
2/52 can commence static/isometric rotator cuff strengthening in neutral. Progress to isometrics thro range.
Commence 0-90° active assisted elevation and active lateral rotation beyond neutral as pain and active control allow.
3/52 – 6/52. Progress active assisted to active elevation >90° as pain and control allow.
NB. Concentrate on quality of movement.
Can progress to active-assisted in all directions from 6/52.Please discuss with Catherine Howard / Debbie Prince if want to progress sooner.
Shoulder clinic review at 6/52, 3/12, 6/12 and 1 year.
Resisted light rotator cuff through range >4/52 onwards, if good control. Ensure good scapula upward rotation is maintained throughout movement. Use free weights ~I kilo and light bands
Progress to active controlled movement > 6/52 in all ranges, esp. abduction.
Can start weight bearing with good technique – avoid pec major over dominance. 4 pt kneeling, push up on gym ball on wall, push up plus if able
Use of kinetic chain to facilitate scapula control and normal movement.
Proprioceptive exercises 6/52 onwards
Return to work: Sedentary 4-6 weeks (as pain allows). Physical 3-6 months (as control and strength allows).
Driving: 6 weeks (as pain and range allows) patient confirms they are able to drive safely.
Sport: Non contact 4-6 months. Contact 9-12 months
Swimming: Gentle with modified stroke 6-8 weeks. Freestyle 12 weeks