Applicable to: anterior stabilisation, posterior stabilisation, or combined anterior and posterior stabilisation
Rehabilitation following arthroscopic shoulder stabilisation should progress gradually to allow biological healing of the repaired labrum and capsule to the glenoid. The overall aim is to restore functional range of motion, strength, proprioception and confidence without placing excessive stress across the repair during the early healing period.
The exact rate of progression should be individualised according to the direction and extent of the repair, tissue quality, associated procedures, pre-operative instability pattern and the patient’s functional and sporting requirements.
Approximately 6-12 weeks post-operative
At approximately 6 weeks, the initial period of immobilisation is generally complete and the patient may progressively wean from the sling. The focus of Stage 2 is to gradually restore shoulder movement, re-establish normal scapulothoracic mechanics and commence gentle activation of the rotator cuff while continuing to protect the capsulolabral repair.
Range of Motion
Active-assisted and active range of motion can now be progressively increased under physiotherapy guidance. The aim is a gradual restoration of functional movement rather than aggressively forcing the shoulder to regain full range.
Forward elevation can be progressively increased as tolerated. External and internal rotation should also be restored gradually, with particular attention to the direction of the original instability and repair.
For an anterior stabilisation, avoid aggressive external rotation, particularly when combined with abduction and extension, as this places stress across the anterior capsulolabral repair.
For a posterior stabilisation, avoid aggressive internal rotation across the body, particularly combined flexion, adduction and internal rotation, as this loads the posterior repair.
For a combined anterior and posterior stabilisation, both sets of precautions apply. Range should therefore be restored particularly gradually, without forceful stretching at either end of rotation.
Some stiffness at this stage is expected and is generally preferable to overstressing a healing repair. Physiotherapists should not attempt to forcefully regain the final degrees of motion during the first 12 weeks.
Strength and Scapular Control
Gentle rotator cuff and scapular stabiliser activation can commence and progress during this phase. The emphasis should initially be on neuromuscular control and movement quality rather than resistance.
Isometric internal and external rotation, gentle theraband exercises, scapular retraction, serratus activation and controlled closed-chain exercises can be introduced as tolerated. Exercises should be performed with the arm initially in safer positions close to the body before progressing further away from the trunk.
The aim is to restore coordinated movement between the glenohumeral joint and scapula and to avoid compensatory shoulder hiking or abnormal scapular mechanics.
Proprioception and Dynamic Stability
Gentle proprioceptive work can begin during Stage 2. This may include controlled weight shifts, wall-based closed-chain exercises, ball-on-wall exercises and low-level rhythmic stabilisation.
These exercises are particularly important following instability surgery, as successful rehabilitation involves not only healing of the structural repair but also restoration of dynamic muscular control and joint position awareness.
Activity
The arm can progressively return to light activities of daily living. Heavy lifting, forceful pushing or pulling, repetitive overhead loading and sudden uncontrolled movements should still be avoided.
Gym-based upper-body strengthening, contact sport and high-risk sporting activities are not appropriate during Stage 2.