Arthroscopic Posterior Stabilisation

Acute phase (0-4 weeks)

Goals

• Reduce surgical repair
• Reduce pain
• Commence controlled shoulder range of movement Promote improved proprioceptive acuity

Rehabilitation

• *Safe zone: aim for passive range of movement to 90° elevation, 45° abduction, 0° external rotation by end of second week
• Active assisted/supported range from 2 weeks
• No forced movements/stretch, no combined forward flexion/internal rotation
• Closed kinetic chain/proprioception exercises
• Cuff exercises within the safe zone
• Scapular setting exercises
• Elbow, wrist, hand exercises

Criteria for progression

• Controlled pain
• Adequate range of movement (need adequate rotational range of movement before introducing active through range cuff facilitation work above 90°)
• Compliance with exercises

Intermediate phase (4-8 weeks)

Goals

• Discard use of sling
• Restore functional range of movement
• Re-educate cuff recruitment and scapular control through range
• Enhance proprioception Preserve surgical repair integrity

Rehabilitation

• No passive stretching into combined forward flexion/internal rotation
• Encourage active movement with good control and without apprehension
• Engage cuff and scapular stabilisation
• Proprioceptive exercises
• Progress cuff & scapular recruitment through range
• Hydrotherapy permitted
• Progress kinetic chain integration
• Closed kinetic chain work

Criteria for progression

• Painfree functional range of movement
• Good cuff and scapular control through functional range

Late phase (>8 weeks)

Goals

• Restore full range of movement
• Optimise preparatory and reactive stabilisation
• Optimise cuff and scapular control under load
• Enhance shoulder power, strength and endurance

Rehabilitation

• Regain optimal range of movement into combined positions
• Enhance neuromuscular control through range and incorporated with kinetic chain
• Aim for visible hypertrophy of posterior cuff, trapezius and serratus
• Strengthening and endurance exercises for cuff and scapular musculature
• Preparatory and reactive stabilisation drills in risk positions

Guidelines for return to functional activities