Mehul R Shah, M.D. - Orthopaedic Surgeon - New York Hospital for Joint Diseases - NYU LANGONE MEDICAL CENTER
Mehul R Shah, M.D. - Orthopaedic Surgeon - New York, NY: 212-598-3897, 646-501-7067 - Lake Success, NY: 516-467-8600
Mehul R Shah, M.D. - Orthopaedic Surgeon
Mehul R Shah, M.D. - Orthopaedic Surgeon
Patient Info

Arthroscopic SLAP Repair Rehabilitation Protocol

The intent of this protocol is to provide the therapist and patient with guidelines for the post­operative rehabilitation course after arthroscopic SLAP repair. This protocol is based on a review of the best available scientific studies regarding shoulder rehabilitation. It is by no means intended to serve as a substitute for one's clinical decision making regarding the progression of a patient's post-operative course. It should serve as a guideline based on the individual's physical exam findings, progress to date, and the absence of post-operative complications. If the therapist requires assistance in the progression of a post-operative patient they should consult with Dr. Shah.

Progression to the next phase based on Clinical Criteria and/or Time Frames as Appropriate.

Phase I - Immediate Post Surgical (Weeks 1-4):,

Goals:

  • Maintain / protect integrity of repair
  • Gradually increase passive range of motion (PROM) Diminish pain and inflammation
  • Prevent muscular inhibition
  • Become independent with activities of daily living with modifications

Precautions:

  • Maintain arm in abduction sling / brace, remove only for exercise
  • No active range of motion (AROM) of shoulder
  • No abduction and external rotation
  • No lifting of objects
  • No shoulder motion behind back
  • No excessive stretching or sudden movements No supporting of any weight
  • No lifting of body weight by hands
  • Keep incision clean and dry

Criteria for progression to the next phase (II):

  • Passive forward flexion to at least 125 degrees
  • Passive external rotation (ER) in scapular plane to at least 25 degrees
  • Passive internal rotation (IR) in scapular plane to at least 75 degrees
  • Passive Abduction to at least 90 degrees in the scapular plane

Days 1 to 6:

  • Abduction brace/sling
  • Pendulum exercises
  • Finger, wrist, and elbow AROM
  • Begin scapula musculature isometrics / sets; cervical ROM
  • Cryotherapy for pain and inflammation -Day 1-2: as much as possible (20 minutes of every hour)
    • Day 3-6: post activity, or for pain
  • Sleeping in abduction sling
  • Patient Education: posture, joint protection, positioning, hygiene, etc.

Days 7 to 28:

  • Continue use of abduction sling / brace
  • Pendulum exercises
  • Begin passive ROM to tolerance (these should be done supine and should be pain free)
    • Flexion to 90 degrees
    • ER to 20 degrees only with the arm at the side
    • IR to body/chest
      • Continue Elbow, wrist, and finger AROM / resisted
      • Cryotherapy as needed for pain control and inflammation
      • May resume general conditioning program - walking, stationary bicycle, etc.
      • Aquatherapy / pool therapy may begin at 3 weeks postop

Phase II - Protection / Active motion (weeks 4 - 6):

Goals:

  • Allow healing of soft tissue
  • Do not overstress healing tissue
  • Gradually restore full passive ROM (week 4-6) Decrease pain and inflammation

Precautions:

  • No lifting
  • No supporting of body weight by hands and arms
  • No sudden jerking motions
  • No excessive behind the back movements
  • Avoid upper extremity bike or upper extremity ergometer at all times

Criteria for progression to the next phase (III):

  • Full active range of motion

Week 4-6:

  • Continue use of sling/brace full time until end of week 4
  • Between weeks 4 and 6 may use sling/brace for comfort only Discontinue sling/ brace at end of week 6
  • Initiate active assisted range of motion (AAROM) flexion in supine position
  • Progressive passive ROM until approximately Full ROM at Week 4-6
    • Gentle Scapular/glenohumeral joint mobilization as indicated to regain full passive ROM
  • Initiate prone rowing to neutral arm position
  • Continue cryotherapy as needed
  • May use heat prior to ROM exercises
  • May use pool (aquatherapy) for light active ROM exercises
  • Ice after exercise

Phase III - Early strengthening (weeks 6-12):

Goals:

  • Full active ROM (week 10-12)
  • Maintain full passive ROM
  • Dynamic shoulder stability
  • Gradual restoration of shoulder strength, power, and endurance Optimize neuromuscular control
  • Gradual return to functional activities

Precautions:

  • No heavy lifting of objects (no heavier than 5 lbs.) No sudden lifting or pushing activities
  • No sudden jerking motions
  • No overhead lifting

Criteria for progression to the next phase (IV):

  • Able to tolerate the progression to low-level functional activities
  • Demonstrates return of strength/dynamic shoulder stability
  • Re-establish dynamic shoulder stability
  • Demonstrates adequate strength and dynamic stability for progression to higher demanding work/sport specific activities

Week 6 - 12:

  • Continue stretching and passive ROM (as needed)
  • Dynamic stabilization exercises
  • Initiate strengthening program
    • External rotation (ER)/Internal rotation (IR) with therabands/sport cord/tubing
    • ER side-lying (lateral decubitus)
    • Lateral raises*
    • Full can in scapular plane* (avoid empty can abduction exercises at all times)
    • Prone rowing
    • Prone horizontal abduction
    • Prone extension
    • Elbow flexion
    • Elbow extension

*Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercises

Week 12:

  • Continue all exercise listed above
  • Initiate light functional activities as Dr. Shah permits

Phase IV - Advanced strengthening (12 weeks to 6 months):

Goals:

  • Maintain full non-painful active ROM
  • Advance conditioning exercises for enhanced functional use
  • Improve muscular strength, power, and endurance
  • Gradual return to full functional activities

Week 16 - 20:

  • Continue ROM and self-capsular stretching for ROM maintenance
  • Continue progression of strengthening
  • Advance proprioceptive, neuromuscular activities
  • Light sports (golf chipping/putting, tennis ground strokes), if doing well

Week 20 - 24:

  • Continue strengthening and stretching
  • Continue stretching, if motion is tight
  • May initiate interval sport program (i.e.. golf, doubles tennis, etc..), if appropriate

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