What precautions should be taken after shoulder dislocation arthroscopy rehabilitation?

Precautions After Shoulder Dislocation Arthroscopy Rehabilitation

Following arthroscopic stabilization for shoulder dislocation, immobilization should be limited to 1-6 weeks maximum, with immediate passive range of motion initiated within the first week, and strengthening exercises beginning at 6 weeks post-operatively to optimize return to function while minimizing recurrence risk.

Immobilization Period

• Sling use should range from 1 day to 6 weeks, with the specific duration determined by surgical technique and tissue quality 1
• Professional athletes may use accelerated protocols with immobilization as short as 1 day, though standard protocols typically recommend 3-6 weeks 2, 1
• Avoid prolonged immobilization beyond 6 weeks, as this increases stiffness without reducing recurrence rates 1

Early Phase (Weeks 0-6): Passive Motion Only

• Begin passive range of motion within the first week post-operatively to prevent stiffness and maintain joint mobility 1
• Restrict external rotation to 30° during the first 6 weeks to protect the repaired capsulolabral complex 3
• Limit forward elevation and abduction based on surgeon-specific protocols, typically progressing gradually from 90° to full range by 6-12 weeks 1
• Apply cryotherapy during the first postoperative week to reduce pain and swelling 4
• Avoid all active strengthening exercises during this healing phase to prevent stress on the repair 1

Intermediate Phase (Weeks 6-12): Progressive Strengthening

• Initiate isometric rotator cuff exercises at 6 weeks, starting with pain-free contractions 5, 1
• Begin closed kinetic chain exercises (wall push-ups, weight shifts) before progressing to open chain movements 4
• Progress to light resistance exercises using elastic bands between 6-12 weeks, focusing on rotator cuff and scapular stabilizers 5
• Achieve full passive range of motion by 12 weeks post-surgery in forward elevation, external rotation, and internal rotation 3

Advanced Phase (Weeks 12+): Sport-Specific Training

• Introduce neuromuscular training and proprioceptive exercises after 12 weeks to restore dynamic stability 4
• Progress to sport-specific movements only after achieving full range of motion and adequate strength 2, 1
• For professional athletes using accelerated protocols, return to play averaged 11 weeks (range 9-14 weeks) with 9% recurrence rate 2
• For standard protocols, return to full activity typically occurs at 4-6 months post-operatively 1

Critical Precautions to Prevent Recurrence

• Avoid combined abduction and external rotation positions (the "at-risk" position) during the first 12 weeks, as this stresses the anterior capsule 6
• Do not progress strengthening exercises if pain, swelling, or apprehension develops, as these indicate excessive loading 5
• Restrict contact sports and overhead activities until achieving limb symmetry index >90% for strength testing 4
• Monitor for signs of instability including apprehension, subluxation sensation, or loss of motion 1

Outcome Monitoring

• Assess shoulder strength bilaterally at 6,12, and 24 weeks to track recovery progression 5
• Measure range of motion comparing injured to uninjured shoulder at each rehabilitation milestone 5
• Use patient-reported outcome measures to quantify functional improvement and guide progression 4

Common Pitfalls to Avoid

• Initiating active strengthening before 6 weeks significantly increases risk of repair failure 1
• Progressing external rotation beyond 30° in the first 6 weeks can disrupt the healing capsulolabral complex 3
• Returning to sport based solely on time rather than functional criteria leads to higher recurrence rates 2, 1
• Neglecting scapular stabilization exercises compromises overall shoulder mechanics and increases reinjury risk 5
• Using "accelerated" protocols in non-elite athletes without appropriate tissue quality or surgical technique may increase failure rates 1

The evidence shows substantial variability in rehabilitation protocols, with accelerated approaches (11-week return) demonstrating success in professional footballers but requiring careful patient selection 2. Standard protocols remain safer for most patients, with recurrence rates of 5-28% reported across studies 2, 1. The key distinction is that accelerated protocols require biomechanically stronger arthroscopic repairs and highly motivated, supervised athletes 2.