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This is an open procedure, and access to the Gleno-Humeral joint is typically achieved by detachment of the Subscapularis tendon or Lesser Tuberosity. This reattachment must then be protected post operatively.
General points
Immobilisation
From 0-6 weeks:
Hand, Wrist and Elbow exercises.
Pendular exercises of with gradual progression.
Active assisted elevation in supine as comfort allows.
3 weeks :
Wean out of sling – light activities only.
External Rotation to neutral as comfort allows.
6 weeks:
Start to increase External Rotation, as External Rotation increases, gradually increase elevation Range of movement.
Active assisted exercises progressing to active exercises – utilise short lever, supine & Closed Kinetic Chain if appropriate.
No long lever open chain exercises until 8 weeks
From 8 weeks:
Progress to open chain and long lever – remembering function.
Sub maximal isometrics in neutral – avoiding Subscapularis.
Consider use of the principles of the Deltoid Rehabilitation programme.
From 12 weeks:
Isometrics in variable starting positions progressing to resisted through range and strengthening.
Functional Milestones
Driving: See general principles of rehabilitation
Swimming: 3 months
Golf: 3 months
Light work/gardening: 6-8 weeks
Heavy manual work/gardening: 6 months