Stage 2 Rehabilitation After a Latarjet Procedure and Capsular Repair (Weeks 6 to 12) — Post-operative care

Referral to Physiotherapist

Please commence a stretching (emphasizing external rotation in adduction), theraband strengthening and scapular program for this patient who is now 6 weeks after a Latarjet procedure and capsular repair. I am happy for you to modify the program below depending on the progress of the patient, but do not commence a gym based strengthening program until 12 weeks after surgery

It is now time to introduce a range of motion and strengthening program together with shoulder blade exercises. It will help to have a physiotherapist or exercise physiologist to supervise your rehab. You should see the therapist once or twice each week and do the exercises 3 to 4 times per day, with the whole set of exercises taking 30 to 40 minutes.

PENDULAR EXERCISES

While bending at the waist, let the operated arm relax and swing with gravity. With the hand turned inwards, circle the arm in a clockwise direction, making the circles bigger and bigger. Perform these for 60 seconds. Then with the hand turned outwards, circle the arm in an anticlockwise direction, making the circles bigger and bigger for another 60 seconds.

Pendular exercise: bending at the waist, letting the arm hang and circle

SHOULDER SHRUGS

With your arms relaxed by your side, shrug your shoulders upwards and then backwards in a circular fashion. You should perform 3 sets of 10 repetitions of this movement with a 30 second rest in between. Try to keep the other shoulder muscles relaxed.

Shoulder shrugs: shoulders lifted upwards and rolled backwards

EXTERNAL ROTATION 1

With both elbows by your side and your arms bent at 90 degrees, hold a stick (e.g. cane, cut-off broom stick) between your hands. By using the good arm, gently push the operated arm outward from your body using the stick. Keep your elbow against the side of your body. When you feel the shoulder stretching out, hold this position for 30 seconds and then relax, and then repeat the exercise. It is easiest to perform this exercise lying down. As you feel more comfortable you can perform this exercise standing.

External rotation lying down, pushing the operated arm outward with a stick

EXTERNAL ROTATION 2

Start this exercise 9 weeks after surgery. Standing in a narrow open doorway, elbows bent and hands on the frame. Lean forward through the doorway stretching the arms backwards and outwards. Hold for 10 seconds and repeat 10 times.

External rotation in a doorway, leaning forward with hands on the frame

FORWARD ELEVATION

Standing one foot from the wall, walk the hand up the wall as high as possible. Lean GENTLY into the wall. Hold for 10 seconds and repeat 10 times. This is a good exercise to do in the shower with the warm water running over the shoulder.

Forward elevation: walking the hand up a wall

CROSS BODY STRETCH

Grasp the elbow of the operated arm with the hand of the other arm and pull the elbow of the operated arm GENTLY across the body. Hold for 10 seconds and repeat 10 times.

Cross body stretch: the operated arm pulled gently across the body by the other hand

HAND BEHIND BACK

While standing, grasp the wrist of the operated arm behind the back with the hand of the other arm, and gently lift the operated arm towards the small of the back by bending the elbows. Hold for 10 seconds and repeat 10 times.

Hand behind back: hands clasped behind the back, lifting towards the small of the back

STRENGTHENING EXERCISES

These are to be done with theraband ribbons. The different colours have different grades of stretch. Start with the easy one and work your way up. The following is just a guide. You can progress to a harder band earlier if you feel you are ready.

Resistance	Theraband Colour	Duration
Light	Yellow	1 month
Medium	Red	1 month
Heavy	Green	1 month

EXTERNAL ROTATION: With the theraband around both wrists and the elbows flexed to 90 degrees, rotate the arms outwards stretching the theraband. Keep the elbows CLOSE to the body. Hold for 10 seconds and repeat 10 times.

Theraband external rotation: band around both wrists, elbows at the sides, arms rotating outwards

FORWARD ELEVATION: With the theraband around the door knob and the elbow bent to 90 degrees, push forwards and upwards to stretch the theraband. Hold for 10 seconds and repeat 10 times. Keep the elbow bent with this exercise.

Theraband forward elevation: band anchored behind, elbow bent, pushing forwards and upwards

INTERNAL ROTATION: With the theraband around the doorknob and the elbow flexed to 90 degrees, pull the theraband across the chest whilst keeping the elbow tucked into the side. Hold for 10 seconds and repeat 10 times.

Theraband internal rotation: band anchored to the side, pulling across the chest with the elbow tucked in

EXTENSION AND SHOULDER BLADE SQUEEZE: With the theraband around the doorknob, the elbow flexed to 90 degrees and the elbow by your side, pull backwards to make the theraband stretch out and then squeeze your shoulder blades towards one another. Hold this squeeze for 5 seconds and repeat 10 times.

Theraband extension and shoulder blade squeeze: pulling backwards with the elbow by the side and squeezing the shoulder blades together

FURTHER GUIDELINES for use of the operated arm for weeks 6 to 12.

Carrying Restriction:
Increase to 2 kg at week 6 and increase by 1kg per week
Avoid extreme abduction and external rotation (throwing position- arm cocked)
Light jogging is OK with a gradual increase in speed.
No freestyle, butterfly or backstroke. Breaststroke may commence at 9 weeks.
No weights in the gym till 3 months.