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| Weeks 1–3: phase I |
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| Sling | At all times (including sleeping) when not doing exercises |
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| Exercises | Passive forward flexion (FF) in scapular plane to 90° |
| Passive external rotation (ER) and extension to neutral |
| Elbow/wrist active ROM |
| Scapular isometrics |
| Pain-free submaximal deltoid isometrics |
| Modalities as needed |
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| Advancement criteria | ER to neutral/FF to 90°/minimal pain or inflammation |
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| Weeks 3–6: phase II |
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| Sling | At all times when not doing exercises |
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| Exercises | Active assisted FF in scapular plane to 120°: wand exercises, pulleys |
| Active assisted ER to 30°: wand exercises |
| Manual scapula side-lying exercises |
| Internal/external rotation isometrics in modified neutral (submaximal, pain-free) |
| Modalities as needed |
|
| Advancement criteria | Minimal pain and inflammation |
| ER to 45°/FF to 120° |
| IR/ER strength 4/5 |
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| Weeks 6–12: phase III |
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| Sling | May discontinue |
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| Exercises | Active assisted FF in scapular plane to tolerance |
| Active assisted ER to tolerance (go slow with ER) |
| Begin active assisted ROM for internal rotation |
| Progress scapular strengthening—include closed chain exercises |
| Begin isotonic IR/ER strengthening in modified neutral (pain-free) |
| Begin latissimus strengthening (progress as tolerated) |
| Begin humeral head stabilization exercises (if adequate strength and ROM) |
| Begin upper extremity flexibility exercises |
| Isokinetic training and testing |
| Modalities as needed |
|
| Advancement criteria | Normal scapulohumeral rhythm |
| Minimal pain and inflammation |
| IR/ER strength 5/5 |
| Full upper extremity ROM |
| Isokinetic IR strength 85% of unaffected side |
|
| Weeks 12–18: phase IV |
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| Exercises | Progress to full functional ROM |
| Advance IR/ER strengthening to 90/90 position if required |
| Continue full upper extremity strengthening program |
| Continue upper extremity flexibility exercises |
| Isokinetic strengthening and testing |
| Activity-specific plyometrics program |
| Address trunk and lower extremity demands |
| Begin sport or activity-related program |
|
| Discharge criteria | Pain-free sport or activity-specific program |
| Isokinetic IR/ER strength equal to unaffected side |
| Independent home exercise program |
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