REHABILITATION AFTER ARTHROSCOPIC ANTERIOR INSTABILITY REPAIR 

1.                  Weeks one through four – the patient wears a sling full time and is encouraged to externally rotate the arm only to 0 degrees (the straight-ahead position).

2.                  After four weeks – the sling is discontinued and the patient begins overhead stretching using a rope and pulley.

3.                  After six weeks – the patient begins passive external rotation stretching with a goal of having one-half the amount of external rotation that is present on the opposite (normal) side by the end of twelve weeks postop.  Thera-Band strengthening is also begun after six weeks, using the same 4-pack exercise protocol as described in the section above on rotator cuff rehabilitation.

4.                  Three months postop – the patient may begin working out with weights in the gym.

5.                  Six months postop – the patient is released to full activities including contact sports. 

In the event of significant bone deficiency in which a Latarjet procedure is performed, we tend to go a bit slower on mobilization in order to allow full healing of the coracoid bone graft.  Therefore, after the Latarjet procedure, we keep the patient in a sling for six weeks, allowing external rotation only to 0 degrees.  At the end of six weeks, the patient begins overhead stretching and external rotation stretching.  Strengthening is delayed until three months postop, to allow secure healing of the bone graft as well as full healing of the upper subscapularis tendon (due to the fact that the upper half of the subscapularis is taken down from its insertion during for the exposure in the Latarjet procedure).  At four months postop, the patient may begin working out in the gym, and at six months postop, full unrestricted activities are allowed, assuming that the bone graft is consolidated.

 REHABILITATION AFTER ARTHROSCOPIC POSTERIOR INSTABILITY REPAIR 

The sequence of rehabilitation after arthroscopic posterior instability repair is essentially analogous to that for anterior instability repair.  The patient is kept in a sling for 4 weeks.  During that time, he is allowed passive external rotation as tolerated but no passive internal rotation.  The pillow splint is placed with the large bolster of the pillow anteriorly to keep the arm at approximately 10 degrees of internal rotation, which is closer to the neutral position than we allow during the first four weeks after anterior instability repairs.  At four weeks postop the sling is discontinued and overhead stretching is begun along with external rotation stretching.  Specific internal rotation stretching is not done.  We simply allow the patient to gradually regain internal rotation as the overall shoulder rehabilitation progresses.  At three months postop, the patient may begin working out in the gym, being careful to avoid the “hands-together” bench press.  With the hands located further apart on the bar during the bench press, the force transmission to the shoulder is more in line with the glenoid, protecting the repair.  At six months postop, the patient may return to full unrestricted activities including contact sports.