Shoulder Instability — Posterior Instability Repair

Saint Louis University (SLUCare)

Weight-Bearing

N/A

Key Restrictions

Sling at all times wks 1-4; protect posterior capsule from stretch throughout; limit IR and horizontal adduction to neutral wks 1-6; AAER limit 45 deg wks 4-6; emphasis on posterior cuff eccentrics; isokinetic IR 85% unaffected before Phase IV

Timeline & Phases

Wks 1-4: sling at all times, AROM elbow/wrist, PROM ER to 30 deg, gripping, scapular isometrics, pain-free submaximal deltoid isometrics (start wk 3), protect posterior capsule, limit IR and horizontal adduction to neutral; advancement criteria: ER 30 deg; Wks 4-6: DC sling after wk 4, AAFF to 90 deg, AAER to 45 deg, limit IR and horizontal adduction to neutral, IR/ER isometrics, manual scapular exercises; advancement criteria: ER 45 deg, FF 120 deg, IR/ER 4/5; Wks 6-12: AAFF to 160 deg, AAER to tolerance, begin AROM IR with arm in 45 deg abduction, scapular strengthening (protect posterior capsule), latissimus strengthening, deltoid/RTC isometrics progressing to isotonics (emphasis posterior cuff eccentrics), humeral head stabilization, UE flexibility, isokinetics; advancement criteria: normal scapulohumeral rhythm, full ROM, IR/ER 5/5, isokinetic IR 85%; Wks 12-18: full UE strengthening (emphasize eccentrics), full ROM, IR/ER to 90/90 if required, UE flexibility, isokinetics, plyometrics, sport/activity program; discharge: pain-free sport program, isokinetic IR/ER equal to unaffected, independent HEP

Notes

SLU Sports Medicine and Shoulder Service; diagnosis: glenohumeral instability (posterior); protect posterior capsule from stretch throughout rehab; emphasis on eccentric posterior cuff strengthening; 4-month protocol 2-3 visits/week