Subscapularis Repair

Sutter Health / Palo Alto Medical Foundation · Kevin Roth MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling with abduction pillow at all times wks 1-5 (comfort wks 5-6; D/C wk 6); avoid stretch of anterior capsule and extension throughout Phases I-III; no active IR Phases I-IV; ROM limits throughout wks 1-12: 90° flexion, 45° ER, 20° extension; no resisted IR through Phase IV; biceps tenodesis modifier: no active elbow flexion until wk 4; cycling/running at 12 wks; RTS weight training at 20+ wks with MD clearance

Timeline & Phases

Phase I (wks 1-2): sling with ABD pillow, ROM limited to 90° flexion/45° ER/20° extension, elbow/wrist/hand ROM, ball squeezes, no active IR, avoid anterior capsule stretch and extension | Phase II (wks 2-4): sling with ABD pillow, PROM limited to 45° ER, Codman's pendulums, therapist-assisted FE, scapular isometrics, elbow/wrist/hand ROM, no active IR, avoid anterior capsule stretch and extension | Phase III (wks 4-6): sling continues wks 4-5 (comfort wks 5-6, D/C wk 6), active-assisted ROM begins, deltoid and non-operated RC isometrics at 6 wks, ROM still limited 90°/45°/20°, no resisted IR | Phase IV (wks 6-12): unrestricted AROM against gravity at 6 wks, goals: full ER/135° flex/120° ABD, NO RC RESISTANCE EXERCISES, scapular stabilizer/biceps/triceps/non-operative RC resisted exercises, no resisted IR | Phase V (wks 12-16): RC theraband at 12 wks, lat/biceps/triceps/pecs/rhomboids/deltoids, emphasize ER and latissimus eccentrics, GH stabilization, cycling/running at 12 wks, sport/job-specific activities, UBE endurance | Phase VI (wks 12-20): full AROM, aggressive scapular stabilization and eccentric strengthening, plyometric and throwing/racquet program, endurance, maintain ROM/flexibility | Phase VII (wks 20+): progress to full activities, RTS weight training/skiing/golf/basketball/manual labor with MD clearance

Notes

No publication date on document; subscapularis-specific restrictions: avoid anterior capsule stretch and extension throughout early phases; no active IR through Phase IV (wks 1-12); ROM limits (90° flex/45° ER/20° extension) maintained through Phase III; deltoid and non-operated (not subscapularis) RC isometrics begin at wk 6; no RC resistance exercises Phase IV; ER and latissimus eccentrics emphasized in Phase V; cycling/running permitted at 12 wks; throwing/racquet program begins Phase VI (wks 12-20); RTS weight training at 20+ wks with MD clearance; Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD