Posterior Labral Repair (Arthroscopic or Open)

Physical Therapy Protocol

Phase I – Maximum Protection (0 to 2 Weeks)

Goals:

• Reduce pain and swelling.
• Protect surgical repair.
• Maintain mobility of distal joints (elbow, wrist, hand).

Precautions:

• Sling Use: Sling with all components worn at all times, including while sleeping, except during home exercises and physical therapy.
• Weight-Bearing: No lifting, pushing, or pulling with operative shoulder (Non-Weight Bearing on operative arm).
• ROM Restrictions: Avoid reaching arm behind back or supporting body weight through operative arm.

Range of Motion (ROM):

• Pendulum exercises 3x/day.
• Elbow and wrist active range of motion (AROM).

Strengthening:

• Gentle gripping and wrist exercises.

Phase II – Protected Passive Range of Motion (2 to 4 Weeks)

Goals:

• Reduce pain.
• Initiate passive shoulder motion under therapist supervision.

Precautions:

• Sling Use: Continue full-time sling use.
• Weight-Bearing: No lifting with operative shoulder.
• Keep arm in front of body when out of sling. Do not reach arm behind back.

Range of Motion (ROM) Limits:

• Flexion to 60°.
• Abduction to 90°.
• External Rotation to 45° (arm at side).
• Internal Rotation to neutral (arm at side).

Strengthening:

• Begin gentle scapular isometrics and submaximal pain-free shoulder isometrics in all directions.
• Continue cervical ROM and wrist/hand exercises.

Phase III – Progressive ROM and Early Strengthening (4 to 6 Weeks)

Goals:

• Progress passive ROM and initiate active-assisted ROM.
• Begin light shoulder strengthening exercises.

Precautions:

• Sling Use: Sling during the day; may discontinue at night after Week 6.
• Weight-Bearing: No lifting, pulling, or pushing >2 lbs.
• Avoid internal rotation behind the back.

Range of Motion (ROM) Limits:

• Flexion to 90°.
• Abduction to full as tolerated.
• External Rotation: 45° with arm abducted to 90°; full as tolerated with arm at side.
• Internal Rotation: 30° with arm abducted to 90°.

Strengthening:

• Continue scapular strengthening.
• Begin light Theraband exercises for external rotation (elbow at side).

Phase IV – Strengthening and Neuromuscular Control (6 to 12 Weeks)

Goals:

• Achieve full ROM (except for IR).
• Progress strengthening and introduce neuromuscular control exercises.

Precautions:

• Sling Use: Discontinue at 6 weeks post-op.
• Weight-Bearing:
  • Weeks 6–8: No lifting >5 lbs.
  • Weeks 8–12: Limit lifting to ≤7 lbs.
• Limit internal rotation to 45° until Week 12.

Range of Motion (ROM):

• Active ROM to full as tolerated (except IR).

Strengthening:

• Progress isotonic rotator cuff strengthening (light weights ≤6–8 lbs).
• Add neuromuscular control exercises (PNF patterns, rhythmic stabilization).

Phase V – Advanced Strengthening and Return to Sport (12 Weeks and Beyond)

Goals:

• Restore full ROM in all directions.
• Advance strengthening and functional activities.
• Prepare athletes for throwing or overhead sports.

Precautions:

• Avoid overhead lifting or high-stress activities until cleared by surgeon.

Range of Motion (ROM):

• Full ROM, including internal rotation, allowed after Week 12.

Strengthening:

• Advance to traditional weight training and sport-specific drills as tolerated.
• Begin Thrower’s 10 program for athletes (if applicable).

Return to Sport Criteria:

• Full ROM and strength.
• No pain with activity.
• Surgeon clearance.