The Bankart procedure is performed to increase anterior stability of the shoulder. The following is a guideline for progression of post-operative treatment. The program may however be modified based on your situation and operative findings.
Time required for full recovery is between 4-6 months.
General Information
There may be a loss of external rotation when compared to the other side, but the motion is usually adequate for most activities.
Capsular repair becomes stressed with external rotation. Since the repair
is made with the arm in neutral rotation, external rotation must be limited during early rehabilitation.
Sling:
Sling should be worn most of the times for 6 weeks, especially in
uncontrolled environments (around dogs, kids, in crowds, Immobilization
etc.).
Sling should be worn while sleeping for 6 weeks.
Sling may be removed in controlled environments for light activities like
movement of the elbow and wrist.
It takes roughly 6 weeks to discontinue the sling.
Personal hygeine and clothing:
To wash under the operated arm, bend over at the waist and let the arm passively swing away from the body. It is safe to wash under the arm in this position. Keep your elbow slightly in front of your body; do not reach behind your body. When putting on clothing, lean forward. and pull the shirt up and over the operated arm first. Then put the other arm into the opposite sleeve. To remove the shirt, take the unoperated arm out of the sleeve first, and then slip the shirt off of the operated arm.
0-6 weeks after surgery:
Rehabilitation Goals:
  • Protect the post-surgical shoulder
  • Activate the stabilizing muscles of the gleno-humeral and scapulo-thoracic joints
  • Full active and passive range of motion for shoulder flexion, abduction, internal rotation and external rotation to neutral.
Precautions:
  • Hypersensitivity in axillary nerve distribution is a common occurrence
  • No shoulder external rotation with abduction for 8 weeks to protect repaired tissues
Exercises:
Begin week 5,
  • Gentle shoulder isometrics for internal rotation and external rotation, flexion, extension, adduction and abduction
  • Active assisted and passive range of motion for shoulder flexion, abduction, internal rotation and external rotation to neutral, progressing to active range of motion at week 7
  • Hand gripping
  • Elbow, forearm, and wrist active range of motion
  • Cervical spine and scapular active range of motion
  • Desensitization techniques for axillary nerve distribution
  • Postural exercises
6-12 weeks after surgery: Goals:
  • Full shoulder active range of motion in all cardinal planes
  • Progress shoulder external rotation range of motion gradually to prevent overstressing the repaired anterior tissues of the shoulder
  • Strengthen shoulder and scapular stabilizers in protected position (0° – 45° abduction)
  • Begin proprioceptive and dynamic neuromuscular control retraining
Precautions:

Avoid passive and forceful movements into shoulder external rotation, extension and horizontal abduction.

Exercises:
  • Active assisted and active range of motion in all cardinal planes – assessing scapular rhythm (gradually progress external rotation to full range at the end of 12 weeks)
  • Gentle shoulder mobilizations as needed
  • Rotator cuff strengthening in non-provocative positions (0° – 45° abduction)
  • Scapular strengthening and dynamic neuromuscular control
  • Cervical spine and scapular active range of motion
12-18 weeks after surgery: Goals:
  • Full shoulder active range of motion in all cardinal planes with normal scapulohumeral movement.
  • 5/5 rotator cuff strength at 90° abduction in the scapular plane
  • 5/5 peri-scapular strength
Precautions:
  • All exercises and activities to remain non-provocative and low to medium velocity
  • Avoid activities where there is a higher risk for falling or outside forces to be applied to the arm
  • No swimming, throwing or sports
Exercises:
Motion
  • Posterior glides if posterior capsule tightness is present. More aggressive ROM if limitations are still present
Strength and Stabilization
  • Flexion in prone, horizontal abduction in prone, full can exercises, D1 and D2 diagonals in standing
  • Theraband/cable column/ dumbell (light resistance/high rep) internal and external rotation in 90° abduction and rowing
18-24 weeks after surgery: Goals:
  • Stability with higher velocity movements and change of direction movements.
  • 5/5 rotator cuff strength with multiple repetition testing at 90° abduction in the scapular plane
  • Full multi-plane shoulder active range of motion
Exercises:
Motion
  • Posterior glides if posterior capsule tightness is present
Strength and Stabilization
  • Dumbbell and ball exercises that incorporate trunk rotation and control with rotator cuff strengthening at 90° abduction. Begin working towards more functional activities by emphasizing core and hip strength and control with shoulder exercises
  • TB/cable column/ dumbell IR/ER in 90 abduction and rowing
  • Higher velocity strengthening and control, such as the inertial, plyometrics, rapid Theraband drills
  • Plyometrics should start with 2 hands below shoulder height and progress to overhead, then back to below shoulder with one hand, progressing again to overhead
  • Begin education in sport specific biomechanics with very initial program for throwing, swimming or overhead racquet sports
Beyond 24 weeks after surgery: Goals:
  • To demonstrate stability with higher velocity movements and change of direction movements that replicate sport specific patterns (including swimming, throwing, etc)
  • No apprehension or instability with high velocity overhead movements
  • Improve core and hip strength and mobility to eliminate any compensatory stresses to the shoulder
  • Work capacity cardiovascular endurance for specific sport or work demands
Exercises:
  • Initiate sport specific programs (throwing program, overhead racquet program or return to swimming program) depending on the athlete’s sport
  • High velocity strengthening and dynamic control, such as the inertial, plyometrics, rapid thera-band drills