SYNOPSIS: This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder.

J Orthop Sports Phys Ther 2010;40(3):155-168, Epub 5 February 2010. doi:10.2519/jospt.2010.3186

KEY WORDS: Bankart repair, capsular plication, postoperative rehabilitation, shoulder instability, therapeutic exercise

Study Design: Single-group factorial. Objectives: Quantify glenohumeral joint translations as a function of force using an instrumented measurement system. Our first specific aim was to compare the magnitude of force (N) required to reach capsular end-point between the anterior, posterior, and inferior directions. Our second specific aim was to compare the magnitude of translation (mm) at capsular end-point between the anterior, posterior, and inferior directions. Background: Manual force-displacement techniques are subjective in nature, and the clinician must rely on "feel" to determine capsular end-point. Several investigators have attempted to utilize more objective measures at the glenohumeral joint, however none have quantified the force or displacements necessary to achieve a true capsular end-point. Methods and Measures: An arthrometric technique was used to measure anterior, posterior, and inferior glenohumeral translations in 20 nonimpaired shoulders (11 women and 9 men with a mean age of 20.9 ± 3.6 years). Results: The magnitude of applied force required to reach capsular end-point was significantly different between directions of translations. Anterior-directed translations required a significantly greater magnitude of applied force to reach capsular end-point than inferior-directed translations. The magnitude of translation was not significantly different between directions at capsular end-point. Conclusions: Applied forces in the range of 181 to 203 N are necessary to reach capsular end-point in subjects with nonimpaired shoulders. Anterior translation required significantly higher forces (203.1 ± 13.1 N) to reach capsular end-point than inferior translation (181.4 ± 31.9 N).

J Orthop Sports Phys Ther. 2OO1;31(8):419-431.

Key Words: arthrometer, force-displacement, joint mobilization, laxity, translation