Shoulder Instability — Coracoid Transfer / Glenoid Bone Grafting

Saint Louis University (SLUCare)

Weight-Bearing

N/A

Key Restrictions

Sling at all times including sleep mo 0-1; DC sling at wk 4; no active abduction/FF/ER mo 0-1; passive FF limit 90 deg + ER limit 30 deg mo 0-1; no pulleys mo 0-1; ROM limits mo 1-2 (FF/abduction to 140 deg, ER 45 deg arm at side only, extension to 40 deg); goal scaption 180 + ER 90 by wk 12; avoid wide grip bench press, behind-neck military press, behind-neck lat pulldown; full return pending Dr. Kaar or Dr. Kim approval

Timeline & Phases

Mo 0-1: sling at all times including sleep, AROM neck/elbow/wrist/hand 3-5x/day, wrist 6-way, passive pendulum 3x/day, passive FF to 90 deg neutral rotation + ER to 30 deg arm at side, no pulleys, scapular and deltoid/ER isometrics submaximal, no active abduction/FF/ER, cryotherapy 5+x/day; Mo 1-2: DC sling wk 4, AAROM with limits (FF/abduction to 140 deg, ER 45 deg arm at side only, extension to 40 deg, no ER with arm abducted), active scapular 4-way, supported biceps/triceps light resistance, IR and IR/ER isometrics, normalize scapulohumeral kinematics; Mo 2-4: slowly increase to full ROM, advance isometrics (IR/ER/abduction/extension/FF), isotonic periscapular 4-way, pool exercises, rotator cuff strengthening when AROM full, goal scaption 180 + ER 90 by wk 12; Mo 4-6: full ROM required, high rep/low weight strengthening, pool with paddles, avoid wide grip bench/behind-neck exercises; Mo 6-8: functional training (swimming, tennis, interval throwing), gradual return to sport; return to sport: full ROM, no pain, satisfactory clinical exam, surgeon approval

Notes

SLU Sports Medicine and Shoulder Service; diagnosis: glenohumeral anterior instability with bone loss; covers coracoid transfer and glenoid bone grafting; Dr. Kaar and Dr. Kim; avoid wide grip bench press, behind-neck military press/lat pulldown indefinitely; 4-month protocol 2-3 visits/week