Posterior and posterior inferior capsular shift

rehabilitation protocol

If you’ve had a posterior inferior capsular shift procedure to correct shoulder instability that has led to chronic dislocation, you need to take steps to protect your shoulder while it heals and work with your physical therapist to follow your surgeon’s recommended rehabilitation protocol. While your recovery is unique, each patient must complete four phases of rehabilitation before receiving final clearance from their surgeon.

Phase 1 – Protection Phase

The protection phase lasts for the first six weeks after your surgery and is separated into two stages. You need to take precautions throughout the entirety of the protection phase to safeguard your shoulder and prevent re-injury such as:

  • Wear your gunslinger postoperative brace, adjusting the position of your arm as directed
  • Wear your brace 24 hours a day, except during physical therapy and while bathing
  • Do not lift your arm over your head, at all
  • No unsupervised flexion (forward movement) for six weeks
Protection phase – Stage 1 (weeks 0-4)

Your goals during the first part of the protection phase are to promote healing, start early protected range of motion with a therapist, prevent muscular atrophy, and decrease inflammation and pain. 

During this stage, you and your physical therapist work on introducing some gentle exercises and small movements, including:

  • Gripping exercises
  • Elbow movements in all directions
  • Neck range of motion 
  • Begin passive range of motion movements for your glenohumeral (GH) (ball and socket) joint
  • Passive internal rotation and abduction (lifting your arm to the side)
  • Isometric exercises (holding your arm in a specific position) including raising your arm in front of you, to the side, and behind you

You can ice your shoulder after your therapy sessions and for up to 20 minutes every hour to reduce swelling and pain.

Protection phase – Stage 2 (weeks 4-6)

Your goals in the second stage of the protection phase include increasing your range of motion, normalize your joint function (arthrokinematics), improve your strength, and continue to reduce pain and swelling. 

Your exercises in this stage include range of motion exercises and gentle joint mobilization.

Range of motion exercises

  • Assisted movement of your GH joint
  • External rotation while your arm is extended to the side up to 90 degrees
  • Lifting your arm in front of you (flexion) up to 90 degrees.
  • Internal rotations at up to 45 degrees of flexion
  • Assisted pulleys
  • Gentle self-capsular stretches (stretching your arm across the body or above your head, reaching down your back)

Gentle joint mobilization

Your physical therapist moves your arm and shoulder to normalize the function of different parts of your shoulder joint. 

You can also work on a conditioning program for your trunk, legs, and general cardiovascular endurance. 

At the end of the protection phase, when you’ve met all milestones, you can stop wearing your sling.

Phase 2 – Intermediate Phase

The intermediate phase of your rehabilitation lasts from weeks 6-12. Your goals during this stage of your recovery include:

  • Achieving a full, nonpainful range of motion, excluding internal rotation
  • Normal joint movement
  • Enhanced strength
  • Increase neuromuscular control

You and your therapist work on range of motion and strengthening exercises, such as:

  • Active range of motion including external rotation, lifting your arm to the front and side
  • Pulley work on arm movement to the front, side, and rear
  • Internal rotation to 40 degrees
  • Internal rotation isometrics
  • Internal and external rotations with resistance bands
  • Introduce light dumbells for shoulder abduction and flexion, bicep curls, supported tricep kickbacks, exercises for latissimus dorsi muscles and rhomboids 
  • Dumbbell supraspinatus (lateral raises)
  • Progressive push-ups, starting on the wall, then decreasing the angle

Throughout the intermediate phase, you can continue to apply ice to your shoulder for up to 20 minutes, especially after your physical therapy sessions.

Phase 3 – Dynamic Strengthening Phase

The dynamic strengthening phase lasts from weeks 12-18. In order to start this phase of your rehabilitation, you need to have a full, nonpainful range of motion, no pain or tenderness, and regained 70% of your strength.

Your goals for the dynamic strengthening phase are to:

  • Increase strength, power, and endurance
  • Enhance your neuromuscular control

During this phase of rehabilitation, you focus on high-speed, high-energy strength exercises, diagonal pattern extensions, and eccentric training (lengthening of a muscle while it develops tension and contraction).

You will practice exercises, including:

  • Internal and external rotations with resistance bands
  • Resistance band exercises for your rhomboids, latissimus dorsi, biceps, and triceps
  • Lateral raises
  • Progressive push-ups
  • Shoulder stretches
  • Trunk and leg strengthening
  • Side-lying external rotations
  • Prone arm raises
  • Prone external and internal rotation
  • Upper back strengthening exercises
  • Dynamic stabilization exercises
  • Continued strengthening and lengthening exercises

Phase 4 – Return-to-Activity Phase

You can start the final return-to-activity phase when you have a full range of motion with no pain or tenderness, and you have a satisfactory exam with your surgeon. 

Your goal in the return-to-activity phase is to progressively increase your activities and return to unrestricted function.

During your physical therapy sessions, you continue to work on exercises, including:

  • Resistance band exercises
  • Dumbbell exercises
  • Introduce functional activities you need for daily life and sports

You also progress to the Thrower’s ten protocol.

The Thrower’s Ten include:

  • Diagonal pattern extensions and flexions
  • Internal and external rotation at the waist
  • Internal and external rotation at shoulder level
  • Shoulder abduction to shoulder height
  • Lateral raises
  • Side-lying external rotations
  • Prone horizontal abduction
  • Prone rowing
  • Seated press-ups
  • Push-ups
  • Bicep curls
Diagonal pattern extensions
Diagonal pattern extensions
Shoulder abduction to shoulder height
Shoulder abduction to shoulder height
Seated press-ups
Seated press-ups
Push-ups
Push-ups
Bicep curls
Bicep curls

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