shoulder- instability- arthroscopic anterior capasular repair with subscapular repair
This document, authored by Advanced Continuing Education Institute, outlines a detailed, phase‑based postoperative rehabilitation protocol for patients who have undergone arthroscopic anterior capsular repair combined with subscapularis repair. It begins with protection directives to safeguard the repair (no excessive motion for 8‑10 weeks, no overhead lifting for 10‑12 weeks) and then progresses through five distinct phases spanning from immediate postoperative (Weeks 0‑6) to return‑to‑activity (Months 7‑9). Each phase lists specific goals, entry criteria, range‑of‑motion (ROM) limits, prescribed exercises (isometrics, rhythmic stabilization, scapular strengthening, isotonic strengthening, plyometrics, sport‑specific drills), and adjunct modalities (cryotherapy, core stabilization). The protocol emphasizes gradual ROM restoration, protection of the surgical repair, progressive strength and neuromuscular control development, and functional return criteria based on pain‑free ROM, stability, strength percentages, and isokinetic testing. Copyright and redistribution restrictions are noted throughout.
Topics
Protection Precautions for Subscapularis and Anterior Capsular Repairs
Specific postoperative restrictions to safeguard the repaired structures, including limits on motion, overhead lifting, and sling/immobilizer use.
Phase I – Immediate Post‑operative (Weeks 0‑6): Restrictive Motion
Initial rehabilitation stage focusing on protection, pain control, gentle passive/active‑assistive ROM, submaximal isometrics, proprioception, and early scapular/core activation.
Phase II – Intermediate (Weeks 7‑14): Moderate Protection
Progressive ROM expansion, introduction of isotonic strengthening, manual resistance, and early subscapularis strengthening while preserving repair integrity.
Phase III – Minimal Protection (Weeks 15‑20): Full ROM Consolidation
Criteria‑based transition to full, pain‑free ROM, enhanced muscular endurance, functional drills (e.g., thrower’s program, wall push‑ups), and continued flexibility work.
Phase IV – Advanced Strengthening (Weeks 21‑24): Power Development
Emphasis on high‑intensity isotonic, neuromuscular control, plyometric strengthening, and sport‑specific interval training once strength reaches 75‑80 % of the contralateral side.
Phase V – Return to Activity (Months 7‑9): Sport Reintegration
Final stage guiding gradual, unrestricted sport participation, maintaining mobility, strength, and stability, with entry criteria based on functional ROM, isokinetic testing, and pain‑free status.
Progression Criteria and Milestones Across Phases
Explicit benchmarks (ROM degrees, strength percentages, pain‑free status, isokinetic test results) that dictate advancement from one phase to the next.
Exercise Modalities and Therapeutic Tools
Specific exercises (isometrics, rhythmic stabilization, tubing, scapular strengthening, plyometrics) and adjunct modalities (cryotherapy, core stabilization) prescribed at each stage.