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

POSTERIOR/INFERIOR CAPSULAR SHIFT PROTOCOL

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BASIC PRINCIPLES OF REHABILITATION:

Minimize effects of immobility

Do not over stress healing tissue

Progression based on time and objective criteria

Promote balance between the anterior and posterior structures

PROGRESSION OF TREATMENT:

PROTECTIVE →ROM →STRENGTHENING →FUNCTIONAL

HEALING ↓ ↓ TRAINING

PASSIVE SCAPULAR

↓ ↓

ACTIVE ROTATOR CUFF

MAXIMAL PROTECTION PHASE (0-6 WEEKS):

Goals: Protect repaired structures

• Gunslinger brace (6 weeks)

• No AROM or PROM

MODERATE PROTECTION PHASE (6-8 WEEKS):

Goals: Improve ROM and Isometric strength

• Sling for comfort

• PROM with no limitations

• Isometrics

• Progress to AAROM

• Pendulmn, wand exercises, and pulleys

• Active wrist and elbow exercise

MINIMAL PROTECTION PHASE (8-10 WEEKS):

Goals: Full PROM, improve AROM and strength

• Full PROM

• Scapular Thoracic strengthening exercise

• Progress to strengthening phase when criteria are met

STRENGTHENING PHASE:

CRITERIA: Pain-free AROM and Pain-free with manual muscle testing

• Isotonic shoulder strengthening exercises isolating the rotator cuff-including sidelying external rotation, prone arm raises at 0, 90 & 120°, prone external rotation, and internal rotation at 0 & 90°

• Progress scapulothoracic strengthening exercises

• Dynamic stabilization exercises

• UBE initiated when active flexion to 90° can be performed without substitution

• PNF

FUNCTIONAL PHASE:

CRITERIA: Adequate strength and ability to perform the activities pain-free

• Continue strengthening exercises for scapular and rotator cuff muscles

• Progress to functional activities needed for ADL’s and Sport