Shoulder Reconstruction Rehabilitation
What is shoulder reconstruction?
Shoulder reconstruction surgery is performed to restore stability and function to the shoulder after dislocations, instability, or severe damage to soft tissues like ligaments or the labrum. The glenohumeral joint — the ball and socket joint of the shoulder — is the most mobile joint in the body and consequently the most frequently dislocated. When the structures that provide passive stability — the labrum, glenohumeral ligaments, and joint capsule — are damaged by dislocation or repetitive instability episodes, the shoulder becomes prone to recurrent dislocations that progressively worsen without surgical intervention.
Several surgical procedures are used to address shoulder instability, and understanding which procedure you have had is important because the rehabilitation approach — particularly the precautions and the pace of progression — differs between them.
Bankart repair is the most common shoulder reconstruction procedure. It reattaches the torn anterior labrum and capsulolabral complex to the anterior glenoid rim, restoring the bumper effect that prevents anterior dislocation. It is the procedure of choice for anterior instability with an intact glenoid in young active patients, typically performed arthroscopically. The primary precaution after Bankart repair is avoiding external rotation combined with abduction — the position of maximum anterior capsular stress — for six to eight weeks while the repaired labrum heals to the glenoid.
The Latarjet procedure transfers the coracoid process — a bony projection of the scapula — to the anterior glenoid, addressing instability through both a bony buttress and a dynamic sling effect from the conjoined tendon. It is used preferentially for patients with significant glenoid bone loss, failed previous soft tissue repairs, or contact sport athletes with a high re-dislocation risk where soft tissue repair alone carries unacceptably high recurrence rates. The Latarjet rehabilitation is more complex than Bankart repair, involving protection of both the bone block and the repaired subscapularis muscle during healing.
Capsular shift and plication procedures tighten the stretched capsule in patients with multidirectional instability — typically hypermobile athletes and patients with connective tissue disorders — where the instability involves all directions rather than the purely anterior pattern of traumatic dislocation. The rehabilitation after capsular plication emphasises controlling range of motion to allow the tightened capsule to heal at the correct length, and avoiding the end-range positions that would stretch the repair.
Remplissage — filling the Hill-Sachs lesion in the humeral head with posterior capsule and infraspinatus tendon — is frequently combined with Bankart repair when a significant engaging Hill-Sachs defect is present. It adds an internal rotation restriction to the post-operative precautions.
Why is physiotherapy essential after shoulder reconstruction?
The surgery restores the passive structural stability of the shoulder — but the dynamic stability, provided by the rotator cuff and periscapular muscles, has been compromised by the instability episodes before surgery, the surgical procedure itself, and the period of sling immobilisation. Rebuilding this dynamic stability is the primary goal of rehabilitation, and it determines how well the shoulder functions in the long term and whether re-dislocation occurs.
Physiotherapy is essential for restoring range of motion, building strength and stability around the shoulder to prevent future instability, reducing pain and inflammation, and ensuring safe progression aligned with the healing phase.
What does rehabilitation involve?
In the first six weeks, the arm is immobilised in a sling and the repaired structures are protected while early healing occurs. The specific position and rotation restrictions depend on the procedure performed — your physiotherapist will establish these based on your surgeon's protocol. Physiotherapy during this phase focuses on pendulum exercises, gentle passive range of motion within the permitted limits, hand and wrist exercises, and postural education.
From six to twelve weeks, active shoulder movement is progressively reintroduced as the repaired structures consolidate. Rotator cuff activation beginning in the pain-free range, scapular stabiliser strengthening — lower trapezius, serratus anterior — and progressive range of motion recovery are the rehabilitation priorities. The rotation restrictions from the early phase are progressively relaxed based on healing progress.
From three to six months, strengthening intensifies through increasing ranges and loads. Rotator cuff strengthening, deltoid work, and the sport or activity specific movements that will be required on return to full activity are systematically reintroduced. Real time ultrasound assists in retraining deep rotator cuff and subscapularis activation. Clinical Pilates provides controlled shoulder and scapular strengthening with precise load progression.
From six to twelve months, return to contact sport and overhead sport is guided by objective strength testing — typically requiring at least 90% limb symmetry in rotator cuff and shoulder strength — and sport-specific functional assessment. For contact sport athletes the apprehension test and functional provocative testing must be negative before return to collision is cleared. Rushing return to contact sport is the most common cause of re-dislocation after shoulder reconstruction.
For patients with instability in the context of hypermobility or connective tissue disorders, the rehabilitation approach is modified — the same principles apply but the pace and load parameters are adjusted for the underlying connective tissue laxity that will continue to challenge the repair.
For patients whose shoulder dislocation and reconstruction occurred in a workplace or motor vehicle context, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder rehabilitation and are members of the Australian Physiotherapy Association. For hypermobility-related instability, Yulia Khasyanova's specialist connective tissue expertise is directly relevant.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Shoulder reconstruction surgery is performed to restore stability and function to the shoulder after dislocations, instability, or severe damage to soft tissues like ligaments or the labrum. The glenohumeral joint — the ball and socket joint of the shoulder — is the most mobile joint in the body and consequently the most frequently dislocated. When the structures that provide passive stability — the labrum, glenohumeral ligaments, and joint capsule — are damaged by dislocation or repetitive instability episodes, the shoulder becomes prone to recurrent dislocations that progressively worsen without surgical intervention.
Several surgical procedures are used to address shoulder instability, and understanding which procedure you have had is important because the rehabilitation approach — particularly the precautions and the pace of progression — differs between them.
Bankart repair is the most common shoulder reconstruction procedure. It reattaches the torn anterior labrum and capsulolabral complex to the anterior glenoid rim, restoring the bumper effect that prevents anterior dislocation. It is the procedure of choice for anterior instability with an intact glenoid in young active patients, typically performed arthroscopically. The primary precaution after Bankart repair is avoiding external rotation combined with abduction — the position of maximum anterior capsular stress — for six to eight weeks while the repaired labrum heals to the glenoid.
The Latarjet procedure transfers the coracoid process — a bony projection of the scapula — to the anterior glenoid, addressing instability through both a bony buttress and a dynamic sling effect from the conjoined tendon. It is used preferentially for patients with significant glenoid bone loss, failed previous soft tissue repairs, or contact sport athletes with a high re-dislocation risk where soft tissue repair alone carries unacceptably high recurrence rates. The Latarjet rehabilitation is more complex than Bankart repair, involving protection of both the bone block and the repaired subscapularis muscle during healing.
Capsular shift and plication procedures tighten the stretched capsule in patients with multidirectional instability — typically hypermobile athletes and patients with connective tissue disorders — where the instability involves all directions rather than the purely anterior pattern of traumatic dislocation. The rehabilitation after capsular plication emphasises controlling range of motion to allow the tightened capsule to heal at the correct length, and avoiding the end-range positions that would stretch the repair.
Remplissage — filling the Hill-Sachs lesion in the humeral head with posterior capsule and infraspinatus tendon — is frequently combined with Bankart repair when a significant engaging Hill-Sachs defect is present. It adds an internal rotation restriction to the post-operative precautions.
Why is physiotherapy essential after shoulder reconstruction?
The surgery restores the passive structural stability of the shoulder — but the dynamic stability, provided by the rotator cuff and periscapular muscles, has been compromised by the instability episodes before surgery, the surgical procedure itself, and the period of sling immobilisation. Rebuilding this dynamic stability is the primary goal of rehabilitation, and it determines how well the shoulder functions in the long term and whether re-dislocation occurs.
Physiotherapy is essential for restoring range of motion, building strength and stability around the shoulder to prevent future instability, reducing pain and inflammation, and ensuring safe progression aligned with the healing phase.
What does rehabilitation involve?
In the first six weeks, the arm is immobilised in a sling and the repaired structures are protected while early healing occurs. The specific position and rotation restrictions depend on the procedure performed — your physiotherapist will establish these based on your surgeon's protocol. Physiotherapy during this phase focuses on pendulum exercises, gentle passive range of motion within the permitted limits, hand and wrist exercises, and postural education.
From six to twelve weeks, active shoulder movement is progressively reintroduced as the repaired structures consolidate. Rotator cuff activation beginning in the pain-free range, scapular stabiliser strengthening — lower trapezius, serratus anterior — and progressive range of motion recovery are the rehabilitation priorities. The rotation restrictions from the early phase are progressively relaxed based on healing progress.
From three to six months, strengthening intensifies through increasing ranges and loads. Rotator cuff strengthening, deltoid work, and the sport or activity specific movements that will be required on return to full activity are systematically reintroduced. Real time ultrasound assists in retraining deep rotator cuff and subscapularis activation. Clinical Pilates provides controlled shoulder and scapular strengthening with precise load progression.
From six to twelve months, return to contact sport and overhead sport is guided by objective strength testing — typically requiring at least 90% limb symmetry in rotator cuff and shoulder strength — and sport-specific functional assessment. For contact sport athletes the apprehension test and functional provocative testing must be negative before return to collision is cleared. Rushing return to contact sport is the most common cause of re-dislocation after shoulder reconstruction.
For patients with instability in the context of hypermobility or connective tissue disorders, the rehabilitation approach is modified — the same principles apply but the pace and load parameters are adjusted for the underlying connective tissue laxity that will continue to challenge the repair.
For patients whose shoulder dislocation and reconstruction occurred in a workplace or motor vehicle context, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder rehabilitation and are members of the Australian Physiotherapy Association. For hypermobility-related instability, Yulia Khasyanova's specialist connective tissue expertise is directly relevant.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
