If you have chronic shoulder instability from a congenital deformity, overuse, or a traumatic surgery, your surgeon might recommend anterior stabilization using the Latarjet protocol if conservative treatments don’t heal your shoulder. After shoulder surgery, you work with your surgeon and a physical therapist to complete an extensive rehabilitation protocol to protect and gradually restore your shoulder strength and range of motion.
Phase 1 lasts for approximately three weeks. Your goals during this phase include:
It’s especially important to take precautions to protect your shoulder in the first few weeks after a Latarjet stabilization procedure. The standard precautionary protocols include:
In phase 1, you begin to work with your physical therapist on passive range of motion (PROM) exercises for your arm and active-assisted range of motion (AAROM) in your hand, wrist, and elbow.
Your physical therapist works with you on PROM, including:
You also apply ice to your shoulder for 20 minutes, 4-5 times a day, for cryotherapy to reduce inflammation.
At the end of phase 1, you should show signs of appropriate healing and comply with your precautions and immobilization guidelines. You should also be able to complete your phase 1 activities without pain or difficulty.
During phase 2, which lasts from week 4-9, you work on minimizing your pain and gradually restoring your AROM. You also reduce the amount of time you wear your sling every day.
You still need to take precautions to protect your shoulder during phase 2. You can’t move your shoulder independently until your surgeon and therapist are satisfied with your PROM. You need to avoid lifting anything with the operative arm and avoid excessive external rotation. You should avoid exercises like pushups or pec flys that stress your anterior capsule.
You and your physical therapist work on PROM, including:
At this point, you continue your PROM and add AA/AROM activities as long as you can maintain proper shoulder mechanics. You also add rhythmic stabilization drills, including internal and external rotations and flexion, extension, abduction, and adduction at various elevations.
Your therapist helps you strengthen your scapular retractors and upward rotators. You begin a balanced AROM strengthening program. Within the strengthening program, you need to take certain precautions, including:
At the same time, your physical therapist adds new exercises to your rehabilitation, including:
To clear you for phase 3, your surgeon needs to see that you have:
During phase 3, which lasts from week 10-15, you focus on normalizing your strength, endurance, and neuromuscular control. You should return to chest level full functional activities and have a gradual increase of stress to your anterior joint capsule.
You and your physical therapist take precautions to avoid overstressing your anterior joint capsule. You should avoid any strengthening or functional activities until you have a full range of motion and strength in that plane of movement. While you feel stronger and have less pain at this point, you still need to avoid any contact sports or activities.
During phase 3, your physical therapist continues with the exercises and movements from earlier phases and introduces:
By the end of phase 3, you should demonstrate:
You focus on overhead movements and returning to your regular activities during phase 4, which lasts from week 16-20. Take care to avoid overstressing your anterior capsule. For example, don’t do triceps dips, wide grip bench presses, or military press or lat pulls behind your head. You need to wait before performing overhead athletic moves like throwing until phase 4 is complete, and your surgeon clears you to return to all activities.
During phase 4, you continue the exercises from the previous phases and add:
By the end of phase 4, you pass the following milestones to return to overhead work and sports activities:
If you’re looking for expert orthopedic shoulder surgeons in the Austin area, contact Dr. Benjamin Szerlip today. We support you before, during, and after your Latarjet protocol anterior stabilization
