Anterior Labral Repair (Bankart) Post-Operative Rehabilitation Protocol
Gregory F. Carolan, MD
St Luke’s Orthopaedic Surgery Group
801 Ostrum St. PPH-2
Bethlehem, PA 18015
610-954-1735
Phase I: Immediate Post-Operative Period (Weeks 0-3 Days 0-21)
Goals: Diminish Inflammation and Pain
Protect Integrity of the Repair
Progress PROM
Become Independent in Modified ADLs
Precautions:
Patient to Remain in Sling at all Times except Dressing/Bathing/PT until Week 3
Avoid Stressing Anterior Inferior Labrum (and Repair)
(No Shoulder Ext/IR behind Back/Lifting/ER in Abduction)
Week 0-1 (Days 0-14)
Instruct in Dressing/Bathing/Toileting within Precautions
AROM elbow, wrist, hand, fingers
PROM, shoulder supine forward elevation to 90°
Begin Codman Pendulums & Gentle Scapulothoracic Stabilization/Mobilization
Week 2-3 (Days 15-21)
Patient to Remain in Sling except for Exercises
Keep above but add the Following
PROM Shoulder, Flexion and Abduction 0-90°
PROM Shoulder ER with Elbow at the Side (measured relative to scapular plane)
Limit ER to 25/35/45° per MD (swimmers more, football less)
Phase II: Moderate Protection Period (Weeks 3-6)
Goals: Allow Soft Tissue Healing
Gently Progress PROM to Regain Full PROM by Week 6
No Glenohumeral Strengthening until Phase III
Precautions:
Sling for Patient Comfort Only
May begin to use Extremity for light ADLs (No Lifting Heavier than Coffee Cup)
Week 3-6 (Days 22-44)
Begin Lower Extremity and Core Strengthening, Light Cardio Training
PROM progressing to Full PROM at Week 6 (including ER with Shoulder in Abduction)
Begin Posterior Capsular Stretching if Necessary (added earlier if release done)
Progress Scapulothoracic Stabilization/Mobilization/Isometrics
If Full PROM Achieved, therapist may add AAROM in all Planes only after Week 4
Phase III: Early Strengthening (Weeks 6-12)
Goals: Gain Full AROM or Maintain if Applicable
Gradual Return of Shoulder/Scapular Strength, Power and Endurance
Prepare for Return to Functional Activities
Precautions:
No Lifting > 10 lbs, Sudden Lifting or Pushing, Overhead Lifting
Week 6-12
Progress Gentle PREs in all Planes of Movement (add Biceps PREs last to protect repair)
Add Light PNF Patterns (Bodyblade/Plyoball/etc. in non-Provocative Positions)
Progressive Rotator Cuff Strengthening
Progress Scapulothoracic Stabilization/Mobilization/Strengthening
Phase IV: Functional Rehabilitation (Weeks 12-16)
Week 12-16
Continue Rotator Cuff and Elbow Flexion strengthening
Emphasize Rhythm and Timing with PNFs (Bodyblade Overhead, Plyoball Throwing)
Stabilize Glenohumeral and Scapulothoracic Joint in Functional Position
Continue Total Body Conditioning (Core, Cardio and Lower Extremity)
Month 4-5
Continue Strengthening/Stabilization/PNF
Begin Interval Throwing Program if ROM/Strength Adequate (Overhead Throwers)
Month 6-7
Begin Throwing from the Mound (50-75%) as Tolerated (If Applicable)
Month 7-9
Progress to Full velocity as Tolerated
NB: This is a general program which may be modified by the surgeon or the therapist in consultation with the surgeon based on intra-operative findings, additional procedures preformed, repair stability, and patient biological factors. If in doubt, please check with my office for individual patient specifics. The ultimate goal of the surgery and rehabilitation is to get the labral tear to heal with the least residual functional deficit of the shoulder due to stiffness.