Arthroscopic SLAP Repair Rehab Protocol

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The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone an arthroscopic rotator cuff repair with a superior labrum anterior-posterior tear. It is by no means a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. If a clinician requires assistance in the progression of a post-operative patient they should consult with the referring surgeon.

GENERAL GUIDELINES:

• Focus on protection of surgical site.
• Individualized gradual progression of therapy to promote optimal level of functional independence
• Supervised physical therapy takes place for 3-6 months.
• Progression of rehabilitation will depend on type of SLAP tear repair (ex. Type 1 vs type 2)

GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING (ADLs)

• You may bath/shower surgical site, to wash under operated arm early on bend passively at the waist to let arm passively come away from body
• You may use hand of operated arm in front of body early on but do not raise arm overhead for first 4 weeks
• Avoid extending or placing arm behind back for first 4 weeks
• Can expect to return to using arm with normal daily activities with dressing and self care starting around week 8
• Driving: Return within 8 weeks of surgery, average around 6 weeks
• Return to normal daily activities/work as directed by PT/MD based on demands and goals.

Rehabilitation Progression

PHASE I: Week 0 – 6:

Goals:

• Protect surgical site
• Decrease pain and inflammation
• Minimize side effects of immobilization

Precautions:

• Use of sling for 4 weeks during sleep and daily activities
• No isolated biceps contraction early in phase, at most progressing to elbow flexion active range of motion (AROM) no resistance
• No AROM external rotation, extension or abduction until start of week 5
• Avoid lifting objects heavier than 1-2 pounds for 4 weeks

Exercises:

• Hand gripping
• Pendulum exercises
• Cervical spine active range of motion
• Wrist/hand AROM/active assist range of motion (AAROM) (weeks 1-2)
• Gradual progression of shoulder passive range of motion (PROM) and AROM (begin week 5) 
• Flexion and elevation to 90 degrees
• External rotation to 25-30 degrees
• Internal rotation to 55-60 degrees
• Begin submaximal isometrics for rotator cuff, periscapular and shoulder musculature
• Initiate proprioceptive neuromuscular facilitation (PNF) at week 3-4 within range of motion, progress in week 5-6
• Begin prone exercise strengthening for scapular musculature at week 5-6

PHASE II: Weeks 7-14:

Criteria to advance to Phase II: 

• Flexion and elevation in scapular plane to >90 degrees
• Abduction >90 degrees
• External rotation 45-50 at 45 degrees abduction
• Internal rotation 45-60 at 45 degrees abduction

Goals:

• Gradually restore full AROM and PROM shoulder flexion, abduction, external rotation, internal rotation, extension to tolerance
• Preserve integrity of surgical repair
• Continue to progress gradual strengthening program
• Begin isotonic rotator cuff, periscapular and shoulder strengthening program

Exercises:

• Closed chain push/pull exercises
• Continue PNF strengthening
• Type II repairs: begin submaximal pain free biceps isometrics
• Type IV and complex repairs: continue AROM elbow flexion and extension, no biceps isometric or isotonic strengthening

Phase III:  Week 14 to 20:

Criteria to advance to Phase III:

• Full painfree ROM
• Good shoulder stability

Goals:

• Establish and maintain full ROM
• Continue gradual strengthening program 

Exercises:

• Continue and progress all exercises in prior phase
• Initiate interval sport program

Phase IV:  Week 20-26:

Criteria for advancement to Phase IV:

• Full painfree ROM
• Satisfactory static and stability
• No pain or tenderness

Goals:

• Enhanced muscular strength, power and endurance
• Progress functional activities
• Maintained shoulder stability

Exercises:

• Progress push/pull exercises
• Progress interval sports program
• Progress PNF 
• Plyometric strengthening

Phase V:  Months 6-9:

Criteria for advancement to Phase V:

• Continued pain free ROM

Goals:

• Gradually progress sport activities to unrestrictive participation

Exercises:

• Continue strengthening and stretching program