Posterior Shoulder Instability Repair — Posterior Shoulder Stabilization

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

'Gunslinger' brace (sling with supporting pillow) worn day and night x6 wks except hygiene/therapy Phase I

Key Restrictions

No overhead activity, avoid IR, no active flexion x6 wks Phase I; avoid posterior GH joint mobilizations throughout early phases; limit IR to 40 deg Phase II

Timeline & Phases

Phase I (surgery-6 wks): protect repaired posterior capsule, cryotherapy 20 min q2h, initiate early protected ROM, gunslinger brace (sling with supporting pillow) day/night x6 wks except hygiene/therapy, no overhead activity, avoid IR, no active flexion x6 wks, ROM progression (0-3 wks: PROM advancing to AAROM, max ER 30 deg in scapular plane; 3 wks: max IR 25 deg; 4-6 wks: PROM/AAROM with ER in multiple abduction planes to 90 deg, max elevation in scapular plane 120 deg, abduction 90 deg, IR 35 deg at 45 deg abduction; 4-6 wks AROM: max abduction 90 deg, ER 90 deg, IR 35 deg), 0-4 wks putty gripping/active elbow flex-extend-pro-sup/cervical AROM, 4-6 wks pulleys in scaption/flexion to <120 deg tolerance, gentle self-capsular stretches, grade 1-2 joint mobilizations of scapulothoracic/GH/AC (avoiding posterior GH mobilizations), light elbow/wrist strengthening, walking/Stairmaster/stationary bike with sling on; progress to Phase II with negative impingement pain/apprehension; Phase II (6-12 wks): gradually restore full AROM/PROM, normalize scapular motor control, progress AAROM/AROM per tolerance with IR limited to 40 deg, 6-9 wks pulleys in flexion/abduction/scaption progressing to rhythmic stabilizations and scapular PNF with manual resistance, IR isometrics in slight ER (not past neutral), theraband for ER at neutral, light band strengthening for scap stabilizers (row, extension, depression, horizontal abduction), standing scapular retraction, biceps curl, triceps kickback over table, 10-12 wks continue stretching to maintain ROM, progress ER/IR strengthening from neutral to 45 deg abduction, initiate band/weighted strengthening into flexion/abduction; progress to Phase III with full pain-free ROM, strength at 70% of unaffected side, no tenderness; Phase III (12-18 wks): enhance strength/power/endurance, progress neuromuscular control, initiate inferior GH mobilizations to facilitate abduction, gentle CKC UE weight-bearing on wall, Thrower's 10 program (T, Y, extensions, row), progress endurance/neuromuscular exercises, PNF diagonals with band/manual resistance, plyometric medicine ball program, trunk/LE strength and conditioning, self-capsule stretches progressing to isotonic RTC-isolating strengthening (side-lying ER, prone arm raises at 0/90/120 deg, IR at 0/90 deg), progress to standing strengthening; 18+ wks: progress end-range stretches if needed, prone CKC UE weight-bearing strength, initiate fitness center program (supine bench press, military press, lat pulldown), progress theraband/dumbbell exercises, progress to work/sport functional activities, throwing/overhead hitting ok at 4 months, throw from pitcher's mound at 6 months, return to sport (including collision sports) generally acceptable at 6 months with surgeon/PT clearance

Notes

OSMS Rehabilitation Guidelines; posterior instability is relatively rare with unique risks for repeat injury and symptomatic positions; usually arthroscopic or mini-open repairs progressed slowly to prevent loss of fixation; references Azar/Beaty/Canale Campbell's Operative Orthopedics (2017), Giangarra & Manske Clinical Orthopedic Rehabilitation (2017), and Maxey & Magnusson Rehabilitation for the Postsurgical Orthopedic Patient (2013)