shoulder- slap- arthroscopic slap type iv repair with biceps tenodenosis slap lesion debridement not repair
This document provides a detailed, phase‑based postoperative rehabilitation protocol for patients who have undergone arthroscopic SLAP (Superior Labrum Anterior to Posterior) Type IV repair combined with biceps tenodesis, where the SLAP lesion is debrided rather than repaired. It begins with explicit precautions—no isolated biceps contraction, heavy overhead lifting, or carrying heavy objects on the operative side for three months. The rehabilitation is organized into five sequential phases spanning from day 1 to 9 months post‑surgery. Each phase lists specific goals (e.g., protecting the repair, restoring dynamic stability, regaining full range of motion, building strength and power, and returning to sport), criteria for progression (full painless ROM, stability, strength thresholds, absence of pain), detailed weekly timelines, ROM limits, exercise prescriptions (passive/active assisted ROM, isometrics, tubing, PNF, Thrower’s Ten, plyometrics, interval sport programs), and restrictions (no active flexion or biceps strengthening in early phases). The protocol emphasizes gradual progression based on patient evaluation, careful monitoring of biceps‑related pain, and a structured return‑to‑activity plan that culminates in unrestricted sport participation by 6–9 months.
Topics
Precautions and Early Contraindications
Lists absolute restrictions for the first three months—no isolated biceps brachii contraction, no heavy overhead lifting, and no carrying heavy objects on the surgical side.
Phase I – Immediate Postoperative Restrictive Motion (Day 1–Week 6)
Outlines goals to protect the repair, prevent immobilization effects, and restore dynamic stability. Details weekly ROM limits, sling/immobilizer use, passive and active‑assistive exercises, isometrics (excluding shoulder flexion and biceps), and cryotherapy.
Phase II – Intermediate Moderate Protection (Week 7–14)
Focuses on gradually restoring full active ROM, initiating isotonic and PNF strengthening, introducing the Thrower’s Ten program, and beginning triceps strengthening while still protecting the repair.
Phase III – Minimal Protection and Functional Restoration (Week 13–20)
Sets criteria for entry (full painless ROM, stability, strength). Emphasizes continued stretching, advanced strengthening (Thrower’s Ten, PNF, endurance), light plyometrics, and the start of interval sport programs.
Phase IV – Advanced Strengthening (Week 20–26)
Targets 75‑80 % strength of the contralateral side, enhanced power, and endurance. Continues flexibility, isotonic, PNF, plyometric, and sport‑specific interval training.
Phase V – Return to Activity (Month 6–9)
Defines final criteria (full functional ROM, isokinetic performance, stability, no pain) and outlines gradual progression to unrestricted sport participation while maintaining stretching and strengthening.