Work and Activity Restrictions

• 0–6 weeks: No work, no use of operative hand
• 6 weeks–3 months: 5 lb weight limit in the operative hand (ideally nothing heavier than a fork, knife, or toothbrush); can return to work using the opposite hand only
• 3 months: No lifting greater than 10 pounds
• 4 months: No lifting greater than 20 pounds
• 5 months: No lifting greater than 30 pounds
• 6 months: Released from restrictions; return to full work duties

0–2 Weeks: Wound Rest / Immobilization

• Sling at all times except for elbow, wrist, and hand exercises (flexing and extending the hand, wrist, and elbow)
• Perform these exercises 3–5 times per day

2–6 Weeks: Maintain Motion and Advance Activity

• After 4 weeks, discontinue the sling
• Begin formal physical therapy 4 weeks after surgery with JPL Exercises Phase I
 – Transition to Phase II of JPL Exercises when comfortable with Phase I
 – Perform 3–5 sets of JPL exercises per day, 5 repetitions per set
• Add scapular protraction and retraction exercises
• Incorporate table slides
• Continue elbow, wrist, and hand exercises regularly

6 Weeks–3 Months: Regain ROM

• Begin JPL Exercises Phase III
 – If a warm pool is available, begin pool exercises
• Start gentle strengthening with theraband: internal rotation, external rotation, and low row
• Add progressive resisted exercises (PREs) for scapular stabilizers: seated rows, shoulder extension, and scapular retraction
• Starting 8 weeks post-surgery, gradually begin weight bearing as tolerated

3 Months: Strengthening

• Begin biceps curls and other biceps strengthening exercises
• Begin sport-specific training
• Progress PREs in all planes
• Normalize strength, endurance, neuromuscular control, and power
• Continue JPL exercises at home as needed to maintain ROM

Goals to Progress to Return to Sport

  1. Progress functional activities toward return to activity or sport
  2. Enhance neuromuscular control
  3. Improve strength, power, and endurance
  4. Achieve muscular strength no less than 80% of the contralateral side
  5. Regain full functional ROM
  6. Reach 5/5 scapular and rotator cuff strength