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 · Fracture

Proximal Humerus ORIF

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 2 weeks

Phase 0 – Quiet (Week 0 - 1)

  • Elbow-wrist-hand ONLY
  • Passive elbow flexion/extension ONLY (due to biceps tenodesis)
  • Begin active scapular retraction/protraction exercises with therapist cueing

Phase I – Passive Motion (Week 2 - 6)

Pendulums to warm-up - Passive range of motion

  • Supine external rotation - GRADUALLY increase to full by week 12
    • (limit ER to 30 in this phase)
      • (limit FF to 120 in this phase)

      Phase II – Active Motion (Week 7 - 10)

      Pendulums to warm-up

      Active range of motion with passive stretch to prescribed limits (FF 0-140, ER 0-30/40)

      • SupineSeated External Rotation
      • SupineSeated Forward Elevation
      • Internal rotation – GRADUALLY increase to full by week 12
      • May begin active biceps flexion/extension exercises

      Phase III – Resisted (Week 11 - 15)Pendulums to warm up and continue with phase 2

      • Increased ROM to full with passive stretching at end range
      • Post-operative stiffness diminishes with time – continue on ROM exercises
      • External and Internal Rotation
      • Standing forward punch
      • Seated Rows
      • Shoulder Shrugs
      • Bicep Curls
      • Bear Hugs

      Phase IV – Weight Training (Week 16)

      • 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
      • 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 2-3 months

      Light Swimming 3-4 months

      Golf (Chip & Putt) 3 months

      Golf (Irons & Driver) 4-5 months

      Tennis 4-5 months

      Weight training 4-5 months

      Skiing 6 months

      Contact Sports 6 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.