Latissimus Transfer (Subscap)

Latissimus Transfer (Subscap)

PHASE I: Protected ROM (8 weeks)

• May remove dressing and shower postop day # 3.
• Sutures are all underneath the skin and will dissolve on their own.
• Ice or cold flow systems encouraged for the first week at a minimum: should be used 3-4 times per day.
• Sling should be in place when not performing exercises.
• Hold pendulum exercises until 4 weeks following surgery
• May start active scapular mobility exercises at 6 weeks – Must keep the shoulder musculature relaxed.
• Avoid all active and active assistive exercises until cleared by the surgeon. This includes pulley exercises, wand and supine assisted exercises.
• Initiate exercise program 3 times per day:
  • Immediate elbow, forearm and hand range of motion out of sling
  • Passive external rotation of the shoulder to 30 - instruct family member (start at 6 weeks)
  • PROM into scapular plane elevation to 120 degrees (start at 6 weeks)

PHASE II: Progressive ROM (8 to 12 weeks)

• May discontinue sling.
• Lifting restriction of 5 pounds should be reinforced with patient.
• Start AAROM and AROM – includes pulleys, wand and supine gravity assisted exercises. Emphasize all motions except IR behind the back until 3 months.
• Isolate and strengthen scapular stabilizers.
• Progress PROM and capsular stretching of the shoulder as needed – elevation and external rotation as tolerated
• Avoid resisted training or strengthening. Avoid AROM in positions of subacromial impingement.

PHASE III: ( >12 weeks)

• Discontinue formal lifting restrictions.
• Start progressive rotator cuff and shoulder strengthening at 3 months – isometrics initially
• Initiate isotonic strengthening at 4 months (Theraband, dumbbells, Hughston’s exercises, etc). Include home cuff strengthening program. Continue to emphasize scapular stabilizers.
• Equate active and passive range of motion. Encourage scapulohumeral mechanics during active shoulder motion.
• Simulate work/recreational activities as rotator cuff strength and endurance improve.