ORIF Greater Tuberosity + Bony Bankart

ORIF Greater Tuberosity + Bony Bankart

Outpatient Physiotherapy Phase 1: (Weeks 2-5)

ROM

• Cervical, elbow and wrist ROM
• Supine Passive ROM forward elevation to: 130 external rotation to:20
• Instruct Home Exercise Program

Strengthening

• No cuff strengthening
• Begin and instruct in program of postural correction
• May begin scapular retraction and depression
• Grip strengthening

Sling

• Arm in sling at all times except for exercises and bathing; includes sling at night (sleeping in recliner chair optimal); Discontinue sling at 6 weeks

Outpatient Physiotherapy Phase 2: (Weeks 6-8)

ROM

• Begin self-assisted forward elevation to 90° and progress in 20° increments per week
• Use Pulleys
• Begin self-assisted ER with progressive return to full in 20° increments per week
• IR in scapular plane as tolerated (No IR behind back)
• No cross body adduction
• Grade I-II scapulothoracic and glenohumeral mobilizations

Strength

• No cuff strengthening
• Continue scapular retraction and depression
• Lower extremity aerobic conditioning

Other

• Modalities to decrease pain and inflammation
• Cryotherapy as necessary

Outpatient Physiotherapy Phase 3: (Weeks 9-12)

ROM

• Progressive return to full forward elevation and external rotation
• May begin posterior capsular stretching program
• May begin IR behind back
• Grade III-IV glenohumeral and scapulothoracic mobilizations
• Begin anterior chest wall stretches (pectoralis minor)

Strength

• Instruct in home program and begin submaximal isometrics in flexion, abduction, IR, ER and extension
• Add progressive isotonics with low resistance, high repetitions as tolerated
• Emphasize anterior deltoid strength and scapular stabilization
• Emphasize upper trapezius, serratus anterior force couple rehabilitation to create stable scapular base
• Assess for and correct compensatory movement patterns
• UBE with low resistance
• Continue aerobic conditioning

Outpatient Physiotherapy Phase 4: (> Week 12)

ROM

• Progressive return to full motion in all planes
• Emphasize posterior capsule stretching
• Maintenance home flexibility program

Strength

• Continue rotator cuff and scapular strengthening program
• Progressive increase in resistance as strength improves
• Continue UBE with progressive resistance as tolerated
• Recreation/vocation specific rehabilitation
• Maintenance aerobic conditioning home program