Dr. Anthony A. Schepsis

Coastal Orthopedics
Beverly, MA
Professor of Orthopedic Surgery
Boston University School of Medicine

Connect With Dr. Schepsis

schepsis@comcast.net

Twitter

LinkedIn

Latarjet procedure



                                                Anthony A. Schepsis, M.D.

                                                Coastal Orthopedics

                                                Beverly-Lahey Health

                                                978-927-3040978-927-3040

REHAB PROTOCOL:  Open Latarjet Repair

  1. Phase 1 - Immediate Postoperative Phase “Restrictive Motion”  (Weeks 0 – 6 )

Goals: Protect the anatomic repair

            Prevent negative effects of immobilization

            Promote dynamic stability and proprioception

            Diminish pain and inflammation

Weeks 0 – 6

  • Sling for _6______ weeks
  •  Sleep in immobilize/swathe for __6___ weeks
  • Elbow/Hand ROM
  • Hand gripping exercises
  • ROM restricted:

            _____________________________________________

            _____________________________________________

                        *** NO active ER or Extension or Abduction

  •  Submaximal isometrics for shoulder musculature
  •   Proprioception drills
  •   Cryotherapy, modalities as indicated

Weeks 4 – 6

  • Use of immobilizer for sleep as listed above
  • Start gentle ROM exercises (PROM)

            Pendulums exercises

            ·              Flexion to ____90____ degrees

                        *** NO active ER or Extension or Abduction

            ·            IR in scapular plane to 55-60 degrees

                        ***NOTE:  Rate of progression based on evaluation of patient

  •  No extension or elevation
  •  Continue isometrics and rhythmic stabilization (submax)
  •  Core stabilization program
  •   Initiate scapular strengthening program
  •   Continue use of cryotherapy

Weeks 6 – 8

  •  Gradually improve ROM

            ·            Flexion to __120_____ degrees

            ·            Initiate ER/IR at 45 degrees abd in scapular plane

            ·            ER in scapular plane to __neutral____ degrees

  • May initiate stretching exercises
  • Initiate exercises tubing ER/IR (arm at side)
  • Scapular strengthening
  •  PNF manual resistance

  1. PHASE II – Intermediate Phase:  Moderate Protection Phase  (weeks 10 – 14)

Goals: Gradually restore full ROM (week 14)

            Preserve the integrity of the surgical repair

            Restore muscular strength and balance

            Enhance neuromuscular control

Weeks 9-11

  •  Gradually progress ROM

            ·            Flexion to 160 degrees

            ·            Initiate ER/IR at 45 degrees abd

            ·            ER at 90 degrees abduction:  45 degrees at week 12

            ·            ER to 90 degrees at weeks 14

            ·            IR at 90 degrees abduction:  70 – 75 degrees

  •  Continue to progress isotonic strengthening program
  •  Continue PNF strengthening

  1. PHASE III – Minimal Protection Phase (Week 15 – 20)

Goals: Maintain full ROM

            Improve muscular strength, power and endurance

            Gradually initiate functional activities

Criteria to Enter Phase III

1)             Full non-painful ROM

2)             Satisfactory stability

3)             Muscular strength (good grade or better)

4)             No pain or tenderness

Weeks 15 – 16

  • Continue all stretching exercises (capsular stretches)
  •  Continue strengthening exercise:

            ·            Thrower ten program or fundamental exercises

            ·            PNF manual resistance

            ·            Endurance training

            ·            Restricted sport activities (light swimming, half golf swings)

  • Initiate interval sport program week 16 – 18

Weeks 18 – 20

  • Continue all exercise listed above
  •  Process interval sport program (throwing, etc.)

  1. PHASE IV – Advanced Strengthening Phase (Weeks 21 – 24)

Goals: Enhance muscular strength, power and endurance

            Progress functional activities

            Maintain shoulder mobility

Criteria to Enter Phase IV

1)             Full functional ROM

2)             Satisfactory isokinetic test that fulfills criteria

3)             Satisfactory shoulder stability

4)             No pain or tenderness

Exercises

  •  Gradually progress sport activities to unrestrictive participation
  •  Continue stretching and strengthening program

Website Builder