Bankart Repair Rehabilitation Protocol

The intent of this protocol is to provide guidelines for the post-operative rehabilitation course after arthroscopic Bankart Repair Surgery. This protocol is based on a review of the best available scientific studies regarding shoulder rehabilitation. It is by no means intended to serve as a substitute for clinical decision making regarding the progression of a patient’s post-operative course. It should serve as a guideline based on the individual’s physical exam/findings, progress to date, and the absence of post- operative complications.  If the physical therapist requires assistance in the progression of a post-operative patient they should consult with Dr. Johnson.

Phase I – Immediate Post Surgical (Weeks 1-4):

Goals: Maintain / protect integrity of repair

Gradually increase passive range of motion (PROM)

Diminish pain and inflammation

Prevent muscular inhibition

Become independent with activities of daily living with modifications

Precautions:
Maintain arm in abduction sling / brace, remove only for exercise

  • No active range of motion (AROM) of shoulder
  • No abduction and external rotation
  • No lifting of objects
  • No shoulder motion behind back
  • No excessive stretching or sudden movements
  • No supporting of any weight
  • No lifting of body weight by hands

Keep incision clean and dry

Criteria for progression to the next phase (II):

  • Passive forward flexion to at least 125 degrees
  • Passive external rotation (ER) in scapular plane to at least 75 degrees
  • Passive internal rotation (IR) in scapular plane to at least 75 degrees
  • Passive Abduction to at least 90 degrees in the scapular plane

Week 1:

  • Abduction brace/sling

  • Pendulum exercises

  • Finger, wrist, and elbow AROM

  • Begin scapula musculature isometrics / sets; cervical ROM

  • Cryotherapy for pain and inflammation

    -Day 1-2: as much as possible (20 minutes of every hour)

    -Day 3-6: post activity, or for pain

  • Sleeping in abduction sling

  • Patient Education: posture, joint protection, positioning, hygiene, etc.

 

Week 2-4:

  • Continue use of abduction sling / brace

  • Pendulum exercises

  • Begin passive ROM to tolerance (these should be done supine and should be pain free)

    – Flexion to 90 degrees
    – ER to 20 degrees only with the arm at the side – IR to body/chest

  • Continue Elbow, wrist, and finger AROM / resisted

  • Cryotherapy as needed for pain control and inflammation

  • May resume general conditioning program – walking, stationary bicycle, etc.

  • Aquatherapy / pool therapy may begin (if available) at 3 weeks postop

     

Phase II – Protection / Active motion (weeks 4 – 6):

Goals: Allow healing of soft tissue

Do not overstress healing tissue

Gradually restore full passive ROM (week 4-6)

Decrease pain and inflammation

Precautions:

  • No lifting
  • No supporting of body weight by hands and arms
  • No sudden jerking motions
  • No excessive behind the back movements
  • Avoid upper extremity bike or upper extremity ergometer at all times.

Criteria for progression to the next phase (III):

  • Full active range of motion

WEEK 4-6:

  • Continue use of sling/brace full time until end of week 4

  • Between weeks 4 and 6 may use sling/brace for comfort only

  • Discontinue sling/ brace at end of week 6

  • Initiate active assisted range of motion (AAROM) flexion in supine position

  • Progressive passive ROM until approximately full ROM at Week 4-6.

    • Gentle Scapular/glenohumeral joint mobilization as indicated to regain full passive ROM

       

  • Initiate prone rowing to neutral arm position

  • Continue cryotherapy as needed

  • May use heat prior to ROM exercises

  • May use pool (aquatherapy) for light active ROM exercises

  • Ice after exercise

 

Phase III – Early strengthening (weeks 6-12):

Goals: Full active ROM (week 10-12)
Maintain full passive ROM
Dynamic shoulder stability
Gradual restoration of shoulder strength, power, and endurance Optimize neuromuscular control

Gradual return to functional activities

Precautions:

  • No heavy lifting of objects (no heavier than 5 lbs.)
  • No sudden lifting or pushing activities
  • No sudden jerking motions
    No overhead lifting

Criteria for progression to the next phase (IV):

  • Able to tolerate the progression to low-level functional activities
  • Demonstrates return of strength/dynamic shoulder stability
  • Re-establish dynamic shoulder stability
  • Demonstrates adequate strength and dynamic stability for progression to higher demanding work/sport specific activities.

WEEK 6 – 12:

  • Continue stretching and passive ROM (as needed)

  • Dynamic stabilization exercises

  • Initiate strengthening program

    • External rotation (ER)/Internal rotation (IR) with therabands/sport cord/tubing

    • ER side-lying (lateral decubitus)Lateral raises*
    • Full can in scapular plane* (avoid empty can abduction exercises at all times)
    • Prone rowing
    • Prone horizontal abduction
    • Prone extension
    • Elbow flexion
    • Elbow extension

*Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercises

WEEK 12:

  • Continue all exercise listed above

  • Initiate light functional activities as Dr. Johnson suggests

 

Phase IV – Advanced strengthening (12 weeks to 6 months):

Goals: Maintain full non-painful active ROM

Advance conditioning exercises for enhanced functional use Improve muscular strength, power, and endurance

Gradual return to full functional activities

WEEK 16 – 20:

  • Continue ROM and self-capsular stretching for ROM maintenance

  • Continue progression of strengthening

  • Advance proprioceptive, neuromuscular activities

Light sports (golf chipping/putting, tennis ground strokes), if doing well

WEEK 20 – 24:

  • Continue strengthening and stretching

  • Continue stretching, if motion is tight

  • May initiate interval sport program (i.e. golf, doubles tennis, etc.), if appropriate

     

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