College of Medicine ‐ Jacksonville Department of Orthopaedics Capsular Shift Rehabilitation Protocol (Accelerated) 4555 Emerson Street Suite 100 Jacksonville, FL 32207 904‐633‐0150 904‐633‐0153 Fax Nigel W. Sparks, M.D. Shands Jacksonville Bone and Joint Institute This rehabilitation program goal is to return the patient/athlete to their activity/sport as quickly and safely as possible, while maintaining a stable shoulder. The program is based on muscle physiology, biomechanics, anatomy and the healing process following surgery for a capsular shift. The capsular shift procedure is one where the orthopedic surgeon makes an incision into the ligamentous capsule of the shoulder and pulls the capsule tighter and then sutures together. The ultimate goal is a functional stable shoulder and a return to a pre‐surgery functional level. Phase I: Protection Phase (week 0‐4) Goals: 1. Allow healing of sutured capsule 2. Begin early protected range of motion 3. Retard muscular atrophy 4. Decrease pain/inflammation Week 0‐2 Precautions: 1.Sleep in immobilizer for 4 weeks 2.No overhead activities for 6 weeks 3.Wean from immobilizer and into sling as soon as possible (orthopedist or therapist will tell you when) Exercises: ? Gripping exercises with putty ? Elbow flexion/extension and pronation/supination ? Pendulum exercises ? Rope and pulley active assisted exercises o Shoulder flexion to 90º o Shoulder abduction to 60º ? T‐bar exercises o ER to 45º with arm abducted at 40º o Shoulder flexion/extension ? AROM cervical spine ? Isometrics (Flexors, Extensors, ER, IR, abductors) Weeks 2‐4 Goals: 1. Gradual increase in ROM The Foundation for The Gator Nation An Equal Opportunity Institution
2. Normalize arthrokinematics 3. Improve strength 4. Decrease pain/inflammation Exercises: ? T‐bar active assisted exercises o ER to 60º at 90º of shoulder abduction o IR to 65º at 90º of shoulder abduction o Shoulder flexion/extension to tolerance o Shoulder abduction to tolerance o Shoulder horizontal abduction/adduction o Rope and pulley flexion/extension *All exercises performed to tolerance. Take to point of pain and/or resistance and hold. Gentle self capsular stretches. ? Gentle joint mobilization to reestablish normal arthrokinematics to: o Scapulothoracic joint o Glenohumeral joint o Sternoclavicular joint ? Strengthening exercises o Isometrics o May initiate theraband for ER/IR at 0º abduction ? Conditioning program o Trunk o Lower extremities o Cardiovascular ? Decrease pain/inflammation o Ice, NSAID, modalities Phase II – Intermediate Phase (week 4‐8) Goals: 1. Full, non‐painful ROM at week 6 2.Normalize arthrokinematics 3. Increase strength 4. Improve neuromuscular control Week 4‐6 ? ROM exercises o T‐bar active assisted exercises o Continue all exercises listed above o Gradually increase ROM to full ROM week 6 o Continue self capsular stretches o Continue joint mobilization ? Strengthening exercises o Initiate isotonic dumbbell program o Sidelying ER o Sidelying IR o Shoulder abduction o Supraspinatus o Latissimus dorsi
o o o o o o Rhomboids Biceps curls Triceps extensions Shoulder shrugs Push – ups into chair (serratus anterior) Continue theraband at 0º for ER/IR Initiate neuromuscular control exercises for scapulothoracic joint Week 6‐8 ? Continue all exercises listed above ? Initiate tubing exercises for rhomboids, latissimus dorsi, biceps and triceps Phase III – Dynamic Strengthening Phase (week 9‐15) Week 9‐12 Goals: 1. Improve strength/power/endurance 2. Improve neuromuscular 3. Prepare athlete to throw Criteria To Enter Phase III 1. Full non‐painful ROM 2. No pain or tenderness 3. Strength 70% or better compared to contralateral side Emphasis Of Phase III: ? High speed, high energy exercises ? Eccentric exercises ? Diagonal patterns Exercises ? Throwers ten exercises o Theraband for rhomboids o Theraband for latissimus dorsi o Theraband for biceps o Theraband for diagonal patterns D2 extension o Theraband for diagonal patterns D2 flexion o Continue dumbbell exercises for supraspinatus and deltoid o Continue serratus anterior strengthening exercises push‐ups floor ? Continue trunk/LE strengthening exercises ? Continue neuromuscular exercises ? Continue self capsular stretches Week 12‐15 ? Continue all exercises above ? Initiate plyometrics for shoulder ? ER at 90º abduction ? IR at 90º abduction ? D2 extension plyometrics ? Biceps plyometrics ? Serratus anterior plyometrics Phase IV – Throwing Phase (week 16‐20) ?
Goal: Progressively increase activities to prepare patient for full functional return Criteria To Progress To Phase IV: 1. Full ROM 2. No pain or tenderness 3. Satisfactory clinical exam Exercises: ? Initiate interval throwing program ? Continue throwers ten exercises ? Continue plyometric five exercises o Interval throwing program at 20th week ? Interval throwing program phase II – 24th week o Return to sports – 26th week