Adam Seidl, MD - Board Certified Orthopaedic Surgeon - Shoulder and Elbow Specialist

Adam Seidl, MDBoard Certified Orthopaedic SurgeonShoulder and Elbow Specialist

Shoulder Instability

Anterior Instability Repair

General Instructions

  • Therapy is to being 2 weeks after the surgery.
  • The patient should work with their therapist 1-3X per week until released by the surgeon.
  • Do not add or skip any part of this program. If you have concerns please contact my office.
  • Goals: The 2 main goals of this physical therapy program are to:
  • Have full active and passive range of motion by 3 months after surgery
  • Return to sport by 18-24 weeks after surgery

Sling Wear

  • Patients must wear their sling at all times for the first 6 weeks after surgery, this does include while they are sleeping. Patients may only remove the sling to perform therapy exercises and for showering.

Ice

  • The use of ice or ice machine is encouraged to help control pain and inflammation after surgery.

Questions/Concerns:

  • Therapists – if you have questions or concerns, please contact me directly or my office. Email is best for non-urgent issues: [javascript protected email address]

Protocol

All time points are based on time since surgery:

0-2 Weeks

  • Wrist and Elbow ROM Only

2 Weeks

  • Passive/active assist forward elevation (FE) to 90 degrees
  • Passive/active assist external rotation (ER) to neutral with arm at the side
  • Gentle Isometrics (no ER/IR)
    combined Abductioncombined Abduction

4 Weeks

  • Passive/active assist forward elevation (FE) to 120 degrees
  • Passive/active assist external rotation (ER) to 20 degrees with arm at the side
  • Passive/active assist Abduction to 90 degrees
  • Scapula protraction/retraction (with arm in sling until 6 weeks post-op)
  • No combined Abduction and ER!
    combined Abductioncombined Abductioncombined Abduction

6 Weeks

  • May discontinue sling usage, unless in crowd, or on slippery surfaces
  • Unlimited passive/active assist in FE
  • May being active motion in all planes
  • Posterior glides OK (no anterior)
  • Resisted isometrics (no IR)

8 Weeks

  • Continue to progress with active motion
  • May slowly progress to resisted exercise with therabands
    therabands

12 Weeks

  • May begin sport specific exercises
    sport specific exercisessport specific exercises

18-24 Weeks

  • Return to play with approval of surgeon

Posterior Instability Repair

General Instructions

  • Therapy is to being 2 weeks after the surgery.
  • The patient should work with their therapist 1-3X per week until released by the surgeon.
  • Do not add or skip any part of this program. If you have concerns please contact my office.
  • Goals: The 2 main goals of this physical therapy program are to:
  • Have full active and passive range of motion by 3 months after surgery
  • Return to sport by 18-24 weeks after surgery

Sling Wear

  • Patients must wear their sling at all times for the first 6 weeks after surgery, this does include while they are sleeping. Patients may only remove the sling to perform therapy exercises and for showering.

Ice

  • The use of ice or ice machine is encouraged to help control pain and inflammation after surgery.

Questions/Concerns:

  • Therapists – if you have questions or concerns, please contact me directly or my office. Email is best for non-urgent issues: [javascript protected email address]

Protocol

All time points are based on time since surgery:

0-2 Weeks

  • Wrist and Elbow ROM Only

2 Weeks

  • Passive/active assist forward elevation (FE) to 90 degrees
    forward elevationforward elevation

4 Weeks

  • Passive/active assist forward elevation (FE) to 120 degrees
    forward elevation
  • Passive/active assist Abduction to 90 degrees
    forward elevation
  • Isometrics – no External Rotation (ER)
  • No combined Abduction and IR!

6 Weeks

  • May discontinue sling usage, unless in crowd, or on slippery surfaces
  • Unlimited passive/active assist in FE
  • May being active motion in all planes – to remain less than passive limits
  • Resisted isometrics (no ER)
  • PRE’s – No ER/IR
  • Scapular stabilizers – protraction/retraction
  • Scapular stabilizers
  • Anterior glides OK if needed – no posterior

8 Weeks

  • Passive/active assist internal rotation to 30 degrees with arm at the side
  • Passive/active assist internal rotation at 45 degrees abduction to 30 degrees
  • Continue to progress with active motion
  • May slowly progress to resisted exercise with therabands
  • Therabands

10 Weeks

  • Unlimited internal rotation – passive and active
  • PRE’s – with IR/ER

14 Weeks

  • May begin sport specific exercises
    ExercisesExercises
  • Posterior glides OK if needed

20-24 Weeks

  • Return to play with approval of surgeon

Latarjet (Coracoid Transfer)

Phase I (Weeks 0-4): Protect Repair

  • Sling to be worn at all times except for showering and rehab under guidance of PT
  • Range of Motion – True Supine Passive Range of Motion Only to Patient Tolerance
    • Goals: 140° Forward Flexion, 25° External Rotation in the 30° abducted position, 60-­‐80° Abduction in the plane of the scapula without rotation, Limit Internal Rotation to 45° with the shoulder in the 30°abducted position
    • Maintain elbow at or anterior to mid-axillary line when patient is supine
  • Therapeutic Exercise – No canes or pulleys during this phase
    • Codman Exercies/Pendulums
    • Elbow/Wrist/Hand Range of Motion and Grip Strengthening
    • Isometric Scapular Stabilization
  • Heat/Ice before and after PT sessions Phase II (Weeks 4-10)

Phase II (Weeks 4-10): Protect Repair/ROM

  • Discontinue sling immobilization at 6 weeks post-op
  • Range of Motion
    • 4-6 weeks: PROM - FF and Abduction to tolerance, 45° External Rotation in the 30° abducted position
    • 6-10 weeks: Begin AAROM and AROM as tolerated: ER/IR to tolerance
    • Goals: FF/Abduction > 155⁰, ER/IR >75⁰ at 90⁰ of shoulder abduction
  • Therapeutic Exercise
    • 4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
    • 6-10 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening,
  • Modalities per PT discretion

Phase III (Weeks 10-16): Full restoration of ROM

  • Range of Motion – Progress to full AROM without discomfort
  • Therapeutic Exercise
    • Continue with scapular strengthening
    • Continue and progress with Phase II exercises
    • Begin Internal/External Rotation Isometrics
    • Push up plus (wall, counter, knees on floor, floor)

Phase IV (Months 4-6): Strengthening/Return to Sports

  • Range of Motion – Full without discomfort
  • Therapeutic Exercise – Advance strengthening as tolerated: isometrics > therabands > light weights
    • 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
    • Return to sports at 6 months if approved
  • Modalities per PT discretion

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Location Map

  • Orthopedics - University of Colorado Hospital

    1635 Aurora Ct
    4th Floor
    Aurora, CO 80045

  • UCHealth Lone Tree Clinic

    9548 Park Meadows Dr
    Lone Tree, CO 80124

Credibility Logos

  • The American Board of Orthopaedic Surgery logo
  • American Academy of Orthopedic Surgeons logo
  • American Shoulder And Elbow Surgeons logo
  • Western Orthopaedic Association logo
  • Alpha Omega Alpha
  • Moon Shoulder