#labrumrepair

The Bankart procedure is performed to increase anterior stability of the shoulder. The following is a guideline for progression of post-operative treatment. The program may however be modified based on your situation and operative findings.

Time required for full recovery is between 4-6 months.

General Information

There may be a loss of external rotation when compared to the other side, but the motion is usually adequate for most activities.

Capsular repair becomes stressed with external rotation. Since the repair is made with the arm in neutral rotation, external rotation must be limited during early rehabilitation.

Sling:

Sling should be worn most of the times for 6 weeks, especially in uncontrolled environments (around dogs, kids, in crowds, Immobilization etc.).

Sling should be worn while sleeping for 6 weeks.

Sling may be removed in controlled environments for light activities like movement of the elbow and wrist.

It takes roughly 6 weeks to discontinue the sling.

Personal hygeine and clothing:

To wash under the operated arm, bend over at the waist and let the arm passively swing away from the body. It is safe to wash under the arm in this position. Keep your elbow slightly in front of your body; do not reach behind your body. When putting on clothing, lean forward. and pull the shirt up and over the operated arm first. Then put the other arm into the opposite sleeve. To remove the shirt, take the unoperated arm out of the sleeve first, and then slip the shirt off of the operated arm.

0-6 weeks after surgery:

Rehabilitation Goals:

Protect the post-surgical shoulder

Activate the stabilizing muscles of the gleno-humeral and scapulo-thoracic joints

Full active and passive range of motion for shoulder flexion, abduction, internal rotation and external rotation to neutral.

Precautions:

Hypersensitivity in axillary nerve distribution is a common occurrence

No shoulder external rotation with abduction for 8 weeks to protect repaired tissues

Exercises:

Begin week 5,

Gentle shoulder isometrics for internal rotation and external rotation, flexion, extension, adduction and abduction

Active assisted and passive range of motion for shoulder flexion, abduction, internal rotation and external rotation to neutral, progressing to active range of motion at week 7

Hand gripping

Elbow, forearm, and wrist active range of motion

Cervical spine and scapular active range of motion

Desensitization techniques for axillary nerve distribution

Postural exercises

6-12 weeks after surgery: Goals:

Full shoulder active range of motion in all cardinal planes

Progress shoulder external rotation range of motion gradually to prevent overstressing the repaired anterior tissues of the shoulder

Strengthen shoulder and scapular stabilizers in protected position (0° – 45° abduction)

Begin proprioceptive and dynamic neuromuscular control retraining

Precautions:

Avoid passive and forceful movements into shoulder external rotation, extension and horizontal abduction.

Exercises:

Active assisted and active range of motion in all cardinal planes – assessing scapular rhythm (gradually progress external rotation to full range at the end of 12 weeks)

Gentle shoulder mobilizations as needed

Rotator cuff strengthening in non-provocative positions (0° – 45° abduction)

Scapular strengthening and dynamic neuromuscular control

Cervical spine and scapular active range of motion

12-18 weeks after surgery: Goals:

Full shoulder active range of motion in all cardinal planes with normal scapulohumeral movement.

5/5 rotator cuff strength at 90° abduction in the scapular plane

5/5 peri-scapular strength

Precautions:

All exercises and activities to remain non-provocative and low to medium velocity

Avoid activities where there is a higher risk for falling or outside forces to be applied to the arm

No swimming, throwing or sports

Exercises:

Motion

Posterior glides if posterior capsule tightness is present. More aggressive ROM if limitations are still present

Strength and Stabilization

Flexion in prone, horizontal abduction in prone, full can exercises, D1 and D2 diagonals in standing

Theraband/cable column/ dumbell (light resistance/high rep) internal and external rotation in 90° abduction and rowing

18-24 weeks after surgery: Goals:

Stability with higher velocity movements and change of direction movements.

5/5 rotator cuff strength with multiple repetition testing at 90° abduction in the scapular plane

Full multi-plane shoulder active range of motion