Arthroscopic Posterior Stabilisation

Sling When will I go home? What can I do? What can’t I do?
4 weeks in external rotational brace You will be discharged on the same day as the operation Passive range of movement in safe zone* No forced movements, no combined forward flexion/internal rotation. No lifting

If combined anterior and posterior stabilisation, please use this rehabilitation protocol.

Acute phase (0-4 weeks)

Goals

  • Protect surgical repair
  • Reduce pain
  • Commence controlled shoulder range of movement
  • Promote improved proprioceptive acuity

Rehabilitation

  • *Safe zone: aim for passive range of movement to 90° elevation, 45° abduction, 0° external rotation by end of second week
  • Active assisted/supported range from 2 weeks
  • No forced movements/stretch, no combined forward flexion/internal rotation
  • Closed kinetic chain/proprioception exercises
  • Cuff exercises within the safe zone
  • Scapular setting exercises
  • Elbow, wrist, hand exercises

Criteria for progression

  • Controlled pain
  • Adequate range of movement (need adequate rotational range of movement before introducing active through range cuff facilitation work above 90°)
  • Compliance with exercises

Intermediate phase (4-8 weeks)

Goals

  • Discard sling
  • Gradual/progressive restoration of functional range of movement
  • Re-educate cuff recruitment and scapular control through range
  • Enhance proprioception
  • Preserve surgical repair integrity

Rehabilitation

  • No passive stretching into combined forward flexion/internal rotation
  • Encourage active movement with good control and without apprehension
  • Engage cuff and scapular stabilisation
  • Proprioceptive exercises
  • Progress cuff & scapular recruitment through range
  • Hydrotherapy permitted
  • Progress kinetic chain integration
  • Closed kinetic chain work

Criteria for progression

  • Painfree functional range of movement
  • Good cuff and scapular control through functional range

Late phase (>8 weeks)

Goals

  • Restore full range of movement
  • Optimise preparatory and reactive stabilisation
  • Optimise cuff and scapular control under load
  • Enhance shoulder power, strength and endurance

Rehabilitation

  • Regain optimal range of movement into combined positions
  • Enhance neuromuscular control through range and incorporated with kinetic chain
  • Aim for visible hypertrophy of posterior cuff, trapezius and serratus
  • Strengthening and endurance exercises for cuff and scapular musculature
  • Preparatory and reactive stabilisation drills in risk positions

Guidelines for return to functional activities

Driving Lifting Swimming Golf
6-8 weeks Light lifting 4 weeks. Avoid heavy for 3 months Breaststroke 6 weeks, freestyle 12 weeks 3-6 months

 

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