Superior Capsule Reconstruction

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Sling with supporting abduction pillow worn at all times except hygiene/therapy Phase I; fully discontinued at wk6 Phase II

Key Restrictions

IR limited to 40 deg with shoulder at 60-80 deg abduction Phase I; maintain elbow at anterior/mid-axillary line when supine; no T-bar or pulleys Phase I; delay aggressive AAROM until wk6; limit overhead activities and avoid sudden movements/lifting Phase III

Timeline & Phases

Phase I (surgery-4 wks): protect repaired shoulder, cryotherapy 20 min q2h, distal extremity ROM, gentle PROM within restrictions, sling with abduction pillow worn at all times except hygiene/therapy, no T-bar/pulleys, IR limited to 40 deg at 60-80 deg abduction, maintain elbow at anterior/mid-axillary line supine, max ROM: FF 140 deg, ER 40 deg with elbow at side, abduction 80 deg without rotation, heat before/ice after PT, hand gripping, elbow/forearm/wrist ROM, postural exercises, Codman's exercises/pendulums, scap stabilization isometrics, walking/Stairmaster/stationary bike with sling on; progress to Phase II with negative impingement pain/apprehension; Phase II (4-8 wks): protect repaired shoulder, full sling discontinuation at wk6, delay aggressive AAROM until wk6, max abduction 90 deg/ER in scapular plane 60 deg/ER at 90 deg abduction 40 deg, max IR in scapular plane 60 deg/IR at 90 deg abduction 20 deg, PROM with Phase I goals, gentle AAROM supine, gentle grade 1-2 joint mobilizations, walking/stationary bike; progress to Phase III with pain-free ROM within limits; Phase III (8-12 wks): full shoulder/scapular ROM all planes, muscle activation, limit overhead activities, avoid sudden movements/lifting, restore PROM/AAROM/AROM with appropriate mechanics, sub-maximal shoulder isometrics as tolerated, sub-maximal rhythmic stabilizations, gentle posterior capsular stretch, UBE no resistance, walking/Stairmaster/biking/jogging; 12+ wks: advance strengthening/endurance as tolerated, light weight (1-5 lbs) 8-12 reps 2-3 sets for RTC/deltoid/scapular stabilizers, rhythmic stabilization at greater elevation angles, initiate CKC with partial body weight (quadruped, wall push-ups) progressing to full body weight by wk18 (plank holds, prone walkouts); ok to throw/overhead hitting at 6 months, throw from pitcher's mound at 9 months, return to sport generally acceptable at 6 months with surgeon/PT clearance

Notes

OSMS Rehabilitation Guidelines; arthroscopic repairs progressed slower than open repairs to prevent loss of fixation; if Worker's Compensation patient needing physically demanding job return, schedule BFA at wk14-16 upon MD approval; 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)