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Arthroscopic SLAP Repair Rehab Protocol

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.


  • 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)


  • 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:


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


  • 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


  • 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


  • 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


  • 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


  • Establish and maintain full ROM
  • Continue gradual strengthening program 


  • 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


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


  • 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


  • Gradually progress sport activities to unrestrictive participation


  • Continue strengthening and stretching program