Dr. Mitchell W. Larsen MD
Director of Education
Central Utah Sports Medicine
1055 N 500 W Bld C Ste 121
Provo, UT 84604
(801)373-7350

CAPSULAR SHIFTS FOR TRAUMATIC ANTERIOR/INFERIOR INSTABILITY PROTOCOL

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MAXIMAL PROTECTION PHASE (0-3 WEEKS)

• ROM precaution – determined in OR

• Sling

• Active elbow and wrist exercise

• Except internal rotation secondary to subscapularis re-attachment

• Removal of sling for showering with the arm at the side

MODERATE PROTECTION PHASE (3-6 WEEKS)

• PROM – Progress as tolerated

• AAROM Exercises – Pendulum, supine flexion & ER (neutral/45º abduction) with uninvolved upper extremity or cane (flexion only)

• Active scapular exercises in neutral-shrugs, depression, protraction & retraction

• Sub-maximal shoulder isometrics-except internal rotation

• Progress from AAROM to AROM

• “Quality” movement only – avoid forcing active motion with substitution patterns

• Remember the effects of gravity on the limb, do gravity eliminated motions first, i.e. supine flexion.

• Aquatic Therapy: shoulder submerged inside scapularis plane only

MINIMAL PROTECTION PHASE (6-8 WEEKS)

• Full PROM by 8 weeks

• Begin light resistance on scapular motions (light weight high repetitions)

• Begin Theraband exercise in neutral position. Avoid any substitution pattern particularly with flexion and abduction.

• Progress to strengthening phase when criteria are met