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Surgerical intervention criteria
- Bankart lesion:
- athlete <20 wanting to continue sports
- bony trauma
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Components of GH stability
- jt cohesion/negative pressure
- bony jt conformity
- glenoid labrum
- dynamic stabilizers: RTC, biceps, scapular mm
- static stabilizers: capsular and ligament restraints
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Bankart Rehab Phase I
- Goals: weeks 0-3
- educate athlete
- start mm contractions
- decrease edema and pain
- protect surgical site
- maintain proximal and distal strength
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Bankart Phase I exercises
- Week 1: wear sling at all times except therapy~
- PROM and AAROM allowed: flex to 90 or 110 as long as not R2; ER in scapular plane 40 and IR 60
- Pendulum exercises, wall/door pulleys
- AROM and isometrics for elbow, wrist and hand
- Scap setting
- Day 7 can do suping IR/ER rhythmic stabilization at 45 of abd
- SA strengthening below 90
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Bankart Phase I precautions
- avoid shrug with scap setting and pulleys
- no active ER, abd, or ext.
- shoulder pain needs to dissipate prior to next set
- no GH mobs in anterior direction
- avoid flex and stress to IGHLC
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Bankart Phase II Goals: weels 3-6
- D/C sling with MD permission
- protect surgical site
- neuromuscular re-ed of ER ans scapulothoracic mm
- critical healing time is 0-6 weeks
- athlete can't drive w/out MD approval
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Bankart Phase II exercises
- sub max isometrics for ER and abd.
- pendulums
- scap setting
- rone horizontal abd ext 100
- sideling ER, standing IR/ER thera band
- SA in supine and prone-- closed chain not the best
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Bankart Phase II precautions
- post. capsular tightness can lead to GH superior anterior translation
- weakness of SA presents as increased downward rotation of scap
- avoid resistance to IR until week 6
- avoid prone horizontal abd
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Bankart Phase III Goals
- flex to 11; abd to 110; ER in scapular plane to 40; IR in scapular plane to 60
- no pain with progressive resistance
- normalization of posterior shoulder flexibility
- no should shrug with flexion
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Bankart Phase III exercises
- start IR with light resistance weekd 6
- PNF coupled motions
- GH abd
- IR/ER at 90 abd
- plyos at week 14
- throwing and batting at 4 mo.
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Bankart Return to Play Criteria
- pain free full ROM
- normalized strength
- progressed through throwing or hitting program
- demonstrates good tecnique
- total arc of motion is 180
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