Shoulder Stabilization — Global Shoulder Stabilization — Multi-Directional and Chronic Instability

Mammoth Orthopedic Institute / Sierra Park PT · Timothy Crall MD (US Ski Team Physician); Bartlett White PA-C

Weight-Bearing

N/A (shoulder) — sling x6 weeks

Key Restrictions

Sling x6 weeks; PROM only x6 weeks; ER/IR in neutral limited to 30 deg x6 weeks; no pendulums x6 weeks; MDI variant: flexion/ABD limited to 90 deg x4 weeks, no AROM x12 weeks; chronic instability variant: no AROM restriction past 6 weeks; no isokinetic or isotonic strength x14 weeks; no swimming x6 months; PT starts at 4 weeks for MDI, 5-7 days for chronic instability

Timeline & Phases

4 phases: Phase I (0-6 wks, PROM only, sling x6 wks, sub-max isometrics supine x4 wks — no pendulums), Phase II (6-12 wks, PROM to full by 12 wks; MDI: no AROM x12 wks; chronic: AAROM/AROM progression), Phase III (12-16 wks, AROM and light strength — no isotonic/isokinetic x14 wks, rhythmic stabilization, GH seating exercises), Phase IV (4-6 months, strength through full AROM, CKC, throwing/catching, RTS assessment at 6 months)

Notes

Two variants: Multi-Directional Instability (MDI) and Chronic Shoulder Instability with different ROM/AROM timelines within same document; PT starts at 4 weeks post-op for MDI vs 5-7 days for chronic instability; no AROM x12 weeks for MDI; no swimming x6 months; no PT name or date listed; RTS assessment at 6 months; pass RTS test before impact sports

Surgeon / Author

Timothy Crall MD (US Ski Team Physician); Bartlett White PA-C