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

Bankart Repair

Early Protective Phase (0-5 weeks)

a. Goals:

  • Protect surgical procedure
  • Educate patient on procedure and therapeutic progression
  • Regulate pain and control inflammation
  • Initiate range of motion and dynamic stabilization

b. Treatment Plan (0-3weeks);

  • Sling Immobilization for 5 weeks;
  • Gripping exercises
  • Elbow, wrist and hand ROM
  • Pendulum exercises (weighted & unweighted)
  • PROM to AAROM
  • IR/ER proprioception training (controlled range)
  • Initiate gentle alternating isometrics for IR/ER in scapular plane
  • Initiate passive forward flexion to 900
  • Initiate scapular mobility

c. Treatment Plan (3-5 weeks);

  • ROM Progression
    • Forward flexion to 110° - 130°
    • ER in scapular plane to 45°
    • IR in scapular plane to 60°
  • Progress sub-maximal alternating Isometrics for IR/ER in scapular plane
  • Initiate scapular strengthening
    • Manual scapula retraction
    • Resisted band retraction
      • No shoulder extension past trunk
  • Isometrics in all directions
  • Continue bicep/tricep strengthening
  • Initiate light band work for IR/ER

d. Milestones for progression

  • Forward flexion to 110° -130°
  • ER in scapular plane to 45°
  • IR in scapular plane to 60°
  • Tolerance of submax Isometrics
  • Knowledge of home care & contraindications
  • Normalize mobility of related joints (AC/SC)

II. Intermediate Phase (5 - 8 weeks)

a. Goals (general)

  • Normalize arthrokinematics
  • Gains in neuromuscular control
  • Normalization of posterior shoulder flexibility

b. Treatment Plan

  • ROM Progression
    • Forward flexion to 150° -165°
    • ER in scapular plane to 65°
    • Full IR in scapular plane
  • Initiate joint mobilizations as necessary
  • Initiate posterior capsular stretching
  • Progress strengthening
    • IR/ER band in scapular plane
    • Side lying ER
    • Full can (no weight if substitution patterns)
    • CW/CCW ball against wall
    • Initiate PNF patterns In available range
    • Body blade at neutral or rhythmic stabilization

c. Milestones for progression

  • Forward flexion to 150° -165°
  • ER in scapular plane to 65°
  • Full IR in scapular plane
  • Symmetrical posterior capsule mobility
  • Progressing isotonic strength with IR/ER in available range

III. Strengthening Phase (8 - 14 weeks)

a. Goals (general)

  • Normalize ROM
  • Progression of strength
  • Normalize scapulothoracic motion & strength
  • Overhead activities without pain

b. Treatment Plan

  • ROM Progression; Initiate IR/ER @90° of GH abduction
    • Within 10° of full AROM in all planes
  • Progression of scapular retractors & stabilizers
    • Prone program; LT, MT, Rhmd
    • LT: scapular depression
  • Progress strengthening
    • Challenging rhythmic stabilization
    • UBE: forward & retro
    • Bilateral ball against wall; progress w/ perturbation
    • Initiate Isokinetic IR/ER in scapular plane
    • Initiate IR/ER @ 90° of GH abduction
    • Isotonic strengthening; flex, abd
    • Closed kinetic chain (ckc) ther-ex

c. Milestones for progression

  • Within 10° of full active range in scapular plane
  • IR/ER <50% deficit
  • <30% strength deficits; primary shoulder muscles & scapular stabilizers

IV. Advanced Strengthening Phase (14 - 24 weeks)

a. Goals (general)

  • Pain free full ROM
  • Improve muscular endurance
  • Improve dynamic stability

b. Treatment Plan

  • Maintain flexibility
  • Progress strengthening
    • Advanced ckc ther-ex
    • Wall push-ups; w/wo ball
    • Continue w/ overhead strengthening
    • Continue w/ Isokinetic IR/ER strengthening; @90° of GH abduction
    • Advance isotonic strengthening
    • Advance rhythmic stabilization training in various ranges and positions
  • Initiate Plyometric strengthening
    • Chest passes
    • Trunk twists
    • Overhead passes
    • 90°/90° single arm plyos

c. Milestones for progression

  • Strength deficits < 20% for IR/ER @ 90° of GH abduction
  • <20% strength deficits throughout

V. Return to Activity & Sport Phase (6 -9 months)

a. Goals (general)

  • Pain free full ROM
  • Normalized strength
  • Return to sport/activity program

b. Treatment Plan

  • Continue Isokinetic training
  • Continue w/ stability training
  • Advance plyometric training
  • Continue w/ ckc ther-ex

c. Milestones for Activity

  • Strength deficits <10% throughout
  • Normalized closed kinetic chain testing
  • Completion of return to sport/activity program

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Sports Medicine - Mehul R Shah, M.D.
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