If you have chronic shoulder instability from a congenital deformity, overuse, or a traumatic surgery, your surgeon might recommend anterior stabilization using the Latarjet protocol if conservative treatments don’t heal your shoulder. After shoulder surgery, you work with your surgeon and a physical therapist to complete an extensive rehabilitation protocol to protect and gradually restore your shoulder strength and range of motion.
Phase 1 – Immediate Post Surgical Phase
Phase 1 lasts for approximately three weeks. Your goals during this phase include:
- Minimizing pain and inflammation
- Protecting the repair
- Gradual restoration of passive range of motion
- Enhance adequate scapular function (your scapula stabilizes your shoulder)
It’s especially important to take precautions to protect your shoulder in the first few weeks after a Latarjet stabilization procedure. The standard precautionary protocols include:
- No active range of motion (AROM)
- Limited external rotation range of motion (stop as soon as you feel it)
- Wear your sling continuously, only take it off to shower
- Don’t lift anything with operative shoulder
- Limit the use of operative extremity even in the absence of pain
- Place a towel or pillow under your shoulder when you lie on your back
In phase 1, you begin to work with your physical therapist on passive range of motion (PROM) exercises for your arm and active-assisted range of motion (AAROM) in your hand, wrist, and elbow.
Your physical therapist works with you on PROM, including:
- Forward flexion and elevation
- Abduction (lifting your arm to the side)
- Internal and external rotations
- Scapular clock exercises
- Ball squeezes
You also apply ice to your shoulder for 20 minutes, 4-5 times a day, for cryotherapy to reduce inflammation.
At the end of phase 1, you should show signs of appropriate healing and comply with your precautions and immobilization guidelines. You should also be able to complete your phase 1 activities without pain or difficulty.
Phase 2 – Intermediate Phase / ROM
During phase 2, which lasts from week 4-9, you work on minimizing your pain and gradually restoring your AROM. You also reduce the amount of time you wear your sling every day.
You still need to take precautions to protect your shoulder during phase 2. You can’t move your shoulder independently until your surgeon and therapist are satisfied with your PROM. You need to avoid lifting anything with the operative arm and avoid excessive external rotation. You should avoid exercises like pushups or pec flys that stress your anterior capsule.
You and your physical therapist work on PROM, including:
- Forward flexion and elevation
- Internal and external rotations
- Glenohumeral (GH) joint (the ball and socket part of your shoulder) mobilizations
- Thoracic spine mobilizations
- Crossbody adduction stretches
- Sleeper stretch
At this point, you continue your PROM and add AA/AROM activities as long as you can maintain proper shoulder mechanics. You also add rhythmic stabilization drills, including internal and external rotations and flexion, extension, abduction, and adduction at various elevations.
Your therapist helps you strengthen your scapular retractors and upward rotators. You begin a balanced AROM strengthening program. Within the strengthening program, you need to take certain precautions, including:
- Starting in low dynamic positions
- Using low weight (1-3 lbs) with increasing reps
- Progress gradually with guidance from your physical therapist
- All exercises should be pain-free and without substitution
At the same time, your physical therapist adds new exercises to your rehabilitation, including:
- 90-degree elevation in the scapular plane (arm at a 45-degree angle in front of you)
- Add resistance to internal and external rotation
- Practice side-lying external rotation with tow rule
- Add manual resistance to external rotations in the scapular plane while lying down
- Introduce prone rowing movements at increasing angles of abduction
To clear you for phase 3, your surgeon needs to see that you have:
- PROM forward elevation to 155 degrees
- PROM external rotation in varying elevations of abduction
- Active forward elevation scapular posture
- Completion of all phase 2 activities without pain
Phase 3 – Strengthening Phase
During phase 3, which lasts from week 10-15, you focus on normalizing your strength, endurance, and neuromuscular control. You should return to chest level full functional activities and have a gradual increase of stress to your anterior joint capsule.
You and your physical therapist take precautions to avoid overstressing your anterior joint capsule. You should avoid any strengthening or functional activities until you have a full range of motion and strength in that plane of movement. While you feel stronger and have less pain at this point, you still need to avoid any contact sports or activities.
During phase 3, your physical therapist continues with the exercises and movements from earlier phases and introduces:
- Bicep curls with light resistance
- Progressive strengthening for your chest muscles
- Progressive push ups (wall, counter, knees on the floor, floor)
- Crossbody diagonal movements with resistance bands
- Internal rotations with resistance
- Forward punches
By the end of phase 3, you should demonstrate:
- Passive forward elevation
- Passive external rotation at all angles of abduction
- Active forward elevation
- Appropriate rotator cuff and scapular muscle performance
- Complete all phase 3 exercises without pain or difficulty
Phase 4 – Overhead Activities / Return to Activity Phase
You focus on overhead movements and returning to your regular activities during phase 4, which lasts from week 16-20. Take care to avoid overstressing your anterior capsule. For example, don’t do triceps dips, wide grip bench presses, or military press or lat pulls behind your head. You need to wait before performing overhead athletic moves like throwing until phase 4 is complete, and your surgeon clears you to return to all activities.
During phase 4, you continue the exercises from the previous phases and add:
- Upper extremity weight lifting, focusing on your larger, primary muscles like deltoid, lats, and pectoralis major. (begin with light weights and high reps)
- Pushups if elbow don’t flex past 90 degrees
- Add plyometrics and interval sports programs if cleared by your physical therapist and surgeon
By the end of phase 4, you pass the following milestones to return to overhead work and sports activities:
- No complaints of pain or instability
- Full range of motion for task completion
- Full strength and endurance of rotator cuff
- Regular completion of at-home exercises
- Clearance from your surgeon
If you’re looking for expert orthopedic shoulder surgeons in the Austin area, contact Austin Shoulder Institute today. We support you before, during, and after your Latarjet protocol anterior stabilization.