Appendix 1.
Post-operative rehabilitation following arthroscopic microfracture procedure with concominant debridement of SLAP type I lesion and subacromial decompression.
| I. Phase 1: protective PROM phase (day 1 post-arthroscopy-week 8) |
| Goals: |
| A. Protect surgical site from undue stress |
| B. Nourish articular cartilage to mold into appropriate tissue |
| C. Prevent negative effects of immobilization |
| D. Decrease pain and inflammation |
| Weeks 1-6 |
| 1. CPM at 90 degrees scaption, 90 degrees ER, 6H daily |
| 2. Cryotherapy as needed |
| Week 7-8 |
| 1. Self-PROM into flexion/scaption |
| 2. Cryotherapy as needed |
| II. Phase 2: AROM and strengthening phase (Week 9-14) |
| Goals: |
| A. Restore full ROM |
| B. Preserve integrity of tissue |
| C. Restore muscular strength and endurance |
| Week 9 |
| 1. Education regarding posture, cryotherapy |
| 2. PROM into glenohumeral flexion, scaption, extension, and external rotation (ER)/internal rotation (IR) in scapular plane |
| 3. Glenohumeral joint mobilizations, grade I-II for pain |
| 4. AAROM/AROM supine into glenohumeral flexion, scaption, ER/IR in scapular plane and neutral abduction |
| 5. Home exercise program (HEP) |
| a. Wand exercises in scaption, flexion, ER/IR in neutral abduction, lOxlOs holds, 5x/day |
| b. Squats, deadlifts with no external resistance |
| c. Isometrics in glenohumeral flexion, abduction, ER/IR in neutral abduction, 2x10 reps, 5s holds, lx/day, 5x/week |
| d. Forearm, wrist, hand-gripping exercises |
| e. Serratus anterior punches supine, 2x10-20 repetitions without external resistance, conducted lx/day, 5x/week |
| f. Tricep extensions/unilateral bicep curls standing, 2x20 repetitions, 5 pounds, 3x/week on non-consecutive days |
| Week 10 |
| 1. Progress PROM adding abduction |
| 2. Joint mobilizations |
| a. ternoclavicular joint, into both superior and inferior direction, grade 11I-1V |
| b. Scapulothoracic joint, into upward rotation, grade TII-IV |
| c. umeral joint, into posterior and inferior direction, grade 11-111 |
| 3. AAROM and AROM- glenohumeral flexion and scaption standing |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Glenohumeral isometrics continued from week 9 |
| d. Forearm, wrist, hand-gripping exercises continued from week 9 |
| e. Increase serratus anterior punches to 1-2 pounds |
| f. Increase bicep/tricep exercises to 10 pounds |
| g. Standing rows with theraband, 2x20 repetitions, 3x/week on non-consecutive days |
| Week 11 |
| 1. Progress PROM adding ER/IR stretching at 90 degrees abduction |
| 2. Joint mobilizations- add grade III-IV to glenohumeral joint, same direction as week 10 |
| 3. AROM glenohumeral scaption and flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Forearm, wrist, hand-gripping exercises continued from week 9 |
| d. Isotonic strengthening for glenohumeral joint, 2x20 repetitions, 3x/week, on non-consecutive days |
| i. Flexion and scaption standing with 1 pound |
| ii. Deltoid wings with 1 -2 pounds |
| iii IR/ER with theraband at neutral abduction |
| e. Increase serratus anterior punches to 3 pounds |
| f. Increase bicep/tricep exercises to 12 pounds |
| g. Standing rows with theraband continued from week 10 |
| Week 12 |
| 1. Progress PROM- add towel stretching behind head and back, wall pectoral stretch at 90 degrees abduction, 10x10 seconds 2-3x/day each, 5x/week |
| 2. Joint mobilizations- add thoracic spine mobilizations, into anterior direction, and continue with GH joint mobilizations from week 11 |
| 3. AROM glenohumeral scaption and flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Forearm, wrist, hand-gripping exercises continued from week 9 |
| d. Isotonic strengthening- glenohumeral joint |
| i. Increase flexion and scaption to 2 pounds |
| ii. Increase deltoid wings to 3 pounds |
| iii. Increase IR/ER with theraband |
| e. Increase serratus anterior punches to 4 pounds |
| f. Increase biceps/triceps exercises to 15 pounds |
| g. Increase standing rows resistance with theraband |
| Week 13 |
| 1. Progress PROM |
| 2. Joint mobilizations- continue from week 12 |
| 3. AROM glenohumeral scaption and flexion continued from week 9 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Forearm, wrist, hand-gripping exercises continued from week 9 |
| d. Isotonic strengthening- glenohumeral joint |
| i. Increase flexion and scaption to 3-4 pounds |
| ii. Increase deltoid wings to 4 pounds |
| iii. Continue with therabands for IR/ER |
| e. Serratus anterior punches continued from week 12 |
| f. Increase biceps/triceps exercises to 20 pounds |
| g. Standing rows continue from week 12 |
| Week 14 |
| 1. Progress PROM |
| 2. Joint mobilizations continued from week 12 |
| 3. AROM glenohumeral scaption and flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Forearm, wrist, hand-gripping exercises continued from week 9 |
| d. Isotonic strengthening- glenohumeral joint |
| i. Increase flexion and scaption to 5 pounds |
| ii. Increase deltoid wings to 5 pounds |
| iii. Increase IR/ER with theraband |
| e. Increase serratus anterior punches to 5 pounds |
| f. Biceps/triceps exercises continued from week 13 |
| g. Standing rows continued from week 13 |
| III. Phase 3: Return to recreational lifting/sport phase (Week 15-) |
| Goals: |
| A. Maintain full ROM |
| B. Improve muscular strength, endurance, and stability |
| C. Gradually return to power lifting tasks |
| Week 15 |
| 1. PROM |
| 2. joint mobilizations as needed, continued from week 12 |
| 3. AROM glenohumeral scaption and flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Squats, deadlifts with no external resistance continued from week 9 |
| c. Forearm, wrist, hand-gripping exercises continued from week 9 |
| d. Wall pushups, 2x20, on stable surface, 3x/week, on non-consecutive days |
| e. Body Blade exercise through full scaption ROM, 3x/week, on non-consecutive days 20x |
| f. Isotonic strengthening- glenohumeral joint |
| i. Flexion/scaption continued from week 14 |
| ii. Deltoid wings continued from week 14 |
| iii. IR/ER with theraband continued from week 14 |
| iv. Scarecrows, 1 -2 pounds, 2x20 |
| g. Serratus anterior punches continued from week 14 |
| h. Increase biceps/triceps exercises to 25 pounds |
| i. Add unilateral bent over rows, 20 pounds, 2x20 repetitions, 3x/week, on non-consecutive days |
| Week 16 |
| 1. PROM |
| 2. Joint mobilizations as needed, continued from week 12 |
| 3. AROM glenohumeral scaption and flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Forearm, wrist, hand-gripping exercises continued from week 9 |
| c. Wall pushups, 2x20, on unstable surface, 3x/week, on non-consecutive days |
| d. Body Blade exercises continued from week 15 |
| e. Dead lifts, 60 pounds, 2x20, 3x/week, on non-consecutive days |
| f. Squats, 95 pounds, 2x20, 3x/week, on non-consecutive days |
| g. Isotonic strengthening- glenohumeral joint |
| i. Flexion/scaption continued from week 14 |
| ii. Deltoid wings continued from week 14 |
| iii. IR/ER with theraband continued from week 14 |
| iv. Increase scarecrows to 3-4 pounds |
| h. Serratus anterior punches continued from week 14 |
| i. Increase biceps/triceps exercises to 30 pounds |
| j. Increase bent over rows to 25 pounds |
| Week 17 |
| 1. PROM |
| 2. Joint mobilizations as needed, continued from week 12 |
| 3. AROM glenohumeral scaption/flexion continued from week 10 |
| 4. HEP |
| a. Wand exercises continued from week 9 |
| b. Forearm, wrist, hand-gripping exercises continued from week 9 |
| c. Add dumbbell bench press, starting with 10 pounds unilaterally |
| d. Body Blade exercises continued from week 15 |
| e. Increase deadlifts to 70 pounds |
| f. Increase squats to 135 pounds |
| g. Isotonic strengthening- glenohumeral joint |
| i. Flexion/scaption continued from week 14 |
| ii. Deltoid wings continued from week 14 |
| iii. IR/ER with theraband continued from week 14 |
| iv. Increase scarecrows to 5 pounds |
| h. Serratus anterior punches continued from week 14 |
| i. Biceps/triceps exercises continued from week 16 |
| j. Increase bent over rows to 30 pounds |