Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Shoulder · Instability & Labrum

HAGL and/or Subscapularis Repair

Post-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.
  • Sling for 6 weeks

Phase 0 – Quiet (Week 0 - 4)

  • Elbow-wrist-hand ONLY
  • Ok to come out of sling for hygiene
  • NO active scapular retraction/protraction exercises
  • Ice: continue to ice on a regular basis. At least 20 minutes at a time, 4-5 times per day.
  • Shower: On post-op day 3
  • Appointment: your first therapy appointment should begin 1 week after surgery

Phase I – Passive Motion (Week 4 - 8)

Weeks 4 – 6:

  • Passive external rotation at 0* abduction – 0*
  • Passive forward elevation – 90*
  • Passive internal rotation - GRADUALLY increase to full by week 12
  • Begin active scapular retraction/protraction exercises

Weeks 6 – 8:

  • Passive external rotation at 0* abduction – 30*
  • Passive forward elevation – 120*
  • Active assisted forward elevation – 90* (pulley)

Phase II – Active Motion (Week 8 - 12)

Weeks 8 – 10:

  • Passive external rotation at 0* & 45* abduction – 45*
  • Passive forward elevation – (140-160*)

Weeks 10 – 12:

  • External rotation at 90* abduction – 90*
  • Full forward elevation
  • Full internal rotation

Phase III – Resisted (Week 13 - 15)Pendulums to warm up and continue with phase 2

  • External and Internal Rotation
  • Standing forward punch
  • Seated Rows
  • Shoulder Shrugs
  • Bicep Curls

Phase IV – Weight Training (Week 16 and beyond)

  • **Avoid anterior capsular/subscapularis stress**
  • Keep hands within eyesight, keep elbows bent, no long lever arms
  • Minimize overhead activities (below shoulder level)
  • No military press, pull-downs behind head, or wide grip bench
  • Gradual progression of resistance controlling velocity, duration, intensity, and frequency
  • Core strengthening and balance training
  • MMI is usually at 12 months post-op

RETURN TO ACTIVITIES

Computer 3-4 weeks

Driving When no longer taking narcotics

Elliptical 1 months

Jogging 2 months

Golf (Chip & Putt) 3 months

Weight training 4 months

Golf (Irons & Driver) 5-6 months

Swimming 6 months

Skiing 7-8 months

Tennis 7-8 months

Contact Sports 7-8 months

Overhead Throwing 7-8 months

**Heavy overhead lifting (military press), pull-down behind head, wide grip bench and dips are discouraged.

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.