Guidelines for Bankart Repair

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Guidelines for Bankart Repair

Rehabilitation Guidelines for SLAP Repair

  1. Early Protective Phase (0-4 weeks)
  2. Goals:
  3. Protect surgical procedure
  4. Educate patient on procedure and therapeutic progression
  5. Regulate pain and control inflammation
  6. Initiate range of motion and dynamic stabilization
  7. Neuromuscular re-education of eternal rotators and scapulothorasic muscles
  1. Treatment Plan (0-2weeks);
  2. Sling immobilization for 2-4 weeks;
  3. Gripping exercises
  4. Elbow, wrist and hand ROM
  5. Pendulum exercises
  6. PROM to AAROM
  7. IR/ER proprioception training (controlled range)
  8. Initiate gentle alternating isometrics for IR/ER in 0° abduction to scapular plane
  9. Initiate passive forward flexion to 90
  10. Initiate scapular mobility
  1. Treatment Plan (2-4 weeks);
  2. ROM Progression
  3. Forward flexion to 110- 130
  4. ER in scapular plane to 35 (position set @ time of surgery)
  5. IR in scapular plane to 60
  6. Progress sub-maximal alternating isometrics for IR/ER in scapular plane
  7. Initiate scapular strengthening
  8. Manual scapula retraction
  9. Resisted band retraction
  • No shoulder extension past trunk
  • Deltoid isometrics in all directions
  • Biceps/triceps strengthening
  • Initiate light band work for IR/ER
  1. Milestones for progression
  • Forward flexion to 90
  • Abduction to 70
  • ER in scapular plane to 30
  • IR in scapular plane to 20
  • Tolerance of submaximal isometrics
  • Knowledge of home care & contraindications
  • Normalize mobility of related joints (AC/SC/ST)
  1. Intermediate Phase (5-8 weeks)
  1. Goals
  2. Normalize arthrokinematics
  3. Gains in neuromuscular control
  4. Normalization of posterior shoulder flexibility
  1. Treatment Plan
  2. ROM Progression
  3. Forward flexion to 150° - 165°
  4. ER in scapular plane to 65°
  5. Full IR in scapular plane
  • Initiate joint mobilizations as necessary
  • Initiate posterior capsular stretching
  • Progress strengthening
  • IR/ER band in scapular plane
  • Side lying ER
  • Scaption full can (no weight if substitution patterns)
  • CW/CCW ball against wall
  • Body blade at neutral or rhythmic stabilization
  1. Milestones for progression
  2. Forward flexion to 160°
  3. ER in scapular plane to 65°
  4. Full IR in scapular plane
  5. Symmetrical posterior capsule mobility
  6. Progressing isotonic strength with IR/ER in available range
  1. Strengthening Phase (9 – 14 weeks)
  1. Goals
  2. Normalize ROM
  3. Progression of strength
  4. Normalize scapulothoracic motion & strength
  5. Overhead activities without pain
  1. Treatment Plan
  2. ROM Progression; stretching ER @ 90° of GH abduction
  3. Within 10° of full AROM in all plans
  4. Progression of scapular retractors & stabilizers
  5. Prone program; LT, MT, Rhmd
  6. LT; scapular depression
  7. Progress strengthening
  8. Challenging rhythmic stabilization
  9. UBE
  10. Initiate Isokinetic IR/ER in scapular plan
  11. Initiate IR/ER @ 90 of GH abduction
  12. Isotonic strengthening; flex, abduction
  13. Closed kinetic chain exercise
  1. Milestones for progression
  2. Within 10 of full active range in scapular plane
  3. Isometric strength IR/ER <50% deficit
  4. <30% strength deficits; primary shoulder muscles & scapular stabilizers
  1. Advanced Strengthening Phase (15 – 24 weeks)
  1. Goals
  2. Pain free full ROM
  3. Improve muscular endurance
  4. Improve dynamic stability
  1. Treatment Plan
  2. Maintain flexibility
  3. Progress strengthening
  4. Advanced closed kinetic chain exercise
  5. Wall push-ups; w/wo ball
  6. Continue w/ overhead strengthening
  7. Continue w/ isokinetic IR/ER strengthening; @ 90° of GH abduction
  8. Advance isotonic strengthening
  9. Advance rhythmic stabilization training in various ranges and positions
  10. Initiate Plyometric strengthening
  11. Chest passes
  12. Trunk twists
  13. Overhead passes
  14. 90/90 single arm plyometrics
  1. Milestones for progression
  2. Full pain free ROM
  3. Strength deficits < 20% for IR/ER @ 90° of GH abduction
  4. <20% strength deficits throughout
  1. Return to Activity & Sport Phase (4 -6 months)
  1. Goals
  • Pain free full ROM
  • Normalized strength
  • Return to sport/activity program
  1. Treatment Plan
  2. Continue Isokinetic training
  3. Continue w/ stability training
  4. Advance plyometric training
  5. Continue w/ Closed kinetic chain exercise
  1. Milestones for Activity
  2. Confidence in shoulder
  3. Strength deficits <10% throughout
  4. Full pain free range of motion
  5. Completion of return to sport/activity program
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