Advanced Shoulder Post-Fracture Rehabilitation

Passive range of motion (PROM) limited to 45 degrees glenohumeral flexion in scapular plane,Pain less than 3/10 at rest,No active contraction of rotator cuff muscles,Tolerance of gentle scapular mobilization techniques,Protected shoulder in sling as prescribed,Minimal inflammation of AC joint and biceps tendon sheath

→ Advance to: Phase II

PROM increased to 60 degrees glenohumeral flexion/abduction,Pain less than 3/10 with passive movements,Isometric contractions of rotator cuff (subscapularis, supraspinatus) initiated at pain-free angles,AC joint strictly non-weight bearing through arm,Biceps tendon loading avoided,Scapular setting exercises in neutral

→ Advance to: Phase II

PROM to 90 degrees glenohumeral flexion and abduction,Full passive glenohumeral external rotation to 45 degrees with elbow at 90 degrees,Isometric rotator cuff contractions progressing to pain-free active assisted range,No labral provocation symptoms with gentle movements,Pain less than 2/10 with activities of daily living,Normal scapulohumeral rhythm with passive assist

→ Advance to: Phase II

Active range of motion (AROM) to 100 degrees flexion,Glenohumeral external rotation to 60 degrees at 90 degrees abduction,AROM external rotation with arm at side to 30 degrees,Initiation of rotator cuff isometric contractions in neutral rotation,Scapular protraction and retraction against gravity,Pain-free biceps tendon glides in supination

→ Advance to: Phase III

AROM flexion to 120 degrees,Full AROM external rotation at 90 degrees abduction,AROM abduction to 90 degrees,Initiated rotator cuff isotonic strengthening with 1 lb weight (supraspinatus, infraspinatus),Scapular stabilization exercises in prone (prone Y, T, W exercises),Labrum stability cues with arm positions below shoulder level

→ Advance to: Phase III

AROM full flexion (150+ degrees),AROM full external rotation at 90 degrees abduction (70-80 degrees),AROM abduction to 120 degrees,Rotator cuff strengthening progressing to 2 lb for supraspinatus and infraspinatus,Biceps strengthening initiated with light resistance (1-2 lb),Scapular control with functional reaching tasks

→ Advance to: Phase III

Full AROM all planes (flexion, abduction, external rotation, internal rotation),Rotator cuff strengthening at 90 degrees abduction for supraspinatus,External rotation at 90 degrees abduction with resistance (3-5 lb),Internal rotation strengthening at 90 degrees abduction,Biceps curls with progressive resistance (3-5 lb),Scapular strengthening with resistance bands

→ Advance to: Phase IV

Full range with good scapulohumeral rhythm,Supraspinatus strengthening at functional angles,External rotation strength 80% of contralateral side,Internal rotation strength 80% of contralateral side,Biceps strength 80% of contralateral side,Scapular stabilization during push-up plus progression

→ Advance to: Phase IV

Rotator cuff endurance testing symmetric,Functional reaching above shoulder level without pain,Labral stability with overhead activities,AC joint asymptomatic with weight-bearing through upper extremity,Biceps tendon load tolerance with sport-specific movements,Scapular control during high-speed arm movements

→ Advance to: Phase IV

External rotation strength 90% of contralateral side at 90 degrees abduction,Internal rotation strength 90% of contralateral side,Plyometric exercises initiated (wall dribbles, chest passes),Sport-specific or occupation-specific movement patterns,Shoulder endurance near baseline,Proprioceptive exercises in all planes

→ Advance to: Phase IV - Completion

Full sport-specific or occupation-specific range of motion,Isokinetic testing within 10% of contralateral side,Advanced plyometric exercises (overhead throws),Return to resistance training progression,Scapular control with loaded overhead movements,Asymptomatic AC joint with CrossFit or equivalent loading

→ Advance to: Phase IV - Completion

Subjective shoulder value (SSV) greater than 90%,Full return to pre-injury activity level,No apprehension with overhead or cross-body movements,Normal glenohumeral translation,Complete labral healing indicators,Clearance for full athletic participation

→ Advance to: Discharge