I feel compelled to write a little in regards to protocol following a slap repair. It is true that if you have had
more than a standard SLAP II repair with more than 2 anchors. then most likely your OS will want to take more precautions. General guidelines include allowing passive movement forward and in the scapular plane very soon after surgery. Moving out to the side in abduction and external rotation must be done with limits. Early safe movement will help to prevent adhesions from forming. Week 1-3 is the protective phase and should include sling use. Beyond the first 3 weeks weaning off the sling is recommended. For the OS that require 6 weeks of sling use, they are essentially using the RC protocol which is not the standard. For those begining PT after 3 weeks, this is fine provided you have been able to work on ROM exercises at home, otherwise starting earlier is prefered. The incredible variability shows that there is really no one standard. This is why I so hightly recommend that you interview a few OS before deciding which one will do surgery. Have them show you the post-op instructions and ask them when they want you to start PT. Most of you who are in pain following PT are now fighting the adhessions that have formed because you were not allowed to do any or limited passive motion. It is a balancing act between protecting the repair and getting the arm moving. If it is surgical technique that allows the OS to feel comfortable allowing one to range the shoulder early then find the OS whos technique allowws for this. Your rehab will be shorter and essentially less painful.

I had a SLAP tear repair with 2 anchors and bone spur removed. My first post-op appointment was 6 days later and started PT twice weekly on my 11th post-op day. We could feel adhesions popping that first day of PT. Starting the day of surgery, I started doing salutes (I call them karate chops) while still in the sling. On my post-op day, he told me I could start wearing the sling without the wedge, but to still sleep with the wedge on. I hate that thing. I don't go for my 2nd appointment until Dec. 4th and am to wear my sling all the time except for showers and PT. But, like you, I have also been taking my arm out of the sling at home. I started that a few days after surgery because my elbow hurt so much and the wedge was putting pressure on a nerve in my upper arm. I was careful though, just to lay it stretched out forward on a pillow without moving my arm at the shoulder away from my body. That felt soooooo good! Once I started PT, he did tell me to take it out to do my exercises twice a day. I'm not supposed to lift anything over a pound. Anyway, from what I was told by the PT, the main purpose of the sling is to protect me from accidently reaching out the wrong way, like if I drop something and the wedge is to keep me from raising my arm above my head or something while sleeping...as if I could even do that right now anyway, LOL.

Wow, do I think my doctor was ultra conservative then....

4 weeks sling no motion
weeks 5-6 pendulums
week 6 PT

2 anchor repair and posterior stabilization.

Am I wrong?

Lain, Actually what makes yours so different from a standard SLAP repair is the added posterior stabilization procedure.
In your case, conservative management is the word, why because the instability was the cause of the tear, so you want to make sure that the shoulder heals tight to prevent any future posterior subluxations or dislocations. This is what I think your OS would say, but why not ask him to explain his rational, even a quick phone conversation would help. Also ask him what motions you should be cautious of in the beginning, usually forward flexion and internal rotation are gradually re-introduced, whereas some like ext rot and abduction can be worked at sooner. This may help you even with pendulums as you start to do these at home. Sharon

HI YOU SEEM TO HAVE A LOT OF EXPERIENCE AM I CRAZY OR BEING A BABY. TODAY I HAD MY STICHES OUT, MY SURGERY WAS ON 11/11/08. I AM KINDA FRUSTRATED WITH MY OS BECAUSE HE MINIMIZES EVERY THING I SAY AND DOES NOT REALLY LISTEN. HIS PA COMES IN TO TALK TO ME THEN HE COMES IN FOR 5 MINS OR LESS. I WANTED TO TREAT WITH AN OS BECAUSE I KNEW THERE WAS SOMETHING WAS MAJORLY WRONG WITH MY ARM/SHOULDER AND I DID NOT WANT TO WASTE TIME GETTING THE WRONG TREATMENT. HE MINIMIZED MY TEAR AND STATED I HAD NO INSTABILITY WHEN I WAS TALKING TO HIM BEFORE SURGERY. I KNEW THIS WAS NOT RIGHT BECAUSE I KEPT TELLING HIM MY ARM WAS SUBLEXING. HE ACTED SURPRISE TO FIND AN EXTENSIVE TEAR DURING SURGERY, AND TOLD MY SON THEY DISLOCATED MY ARM WITH LITTLE EFFORT UNDER ANESTHESIA. I THINK I WANT TO CHANGE MY PRIMARY CARE TO A PAIN MANAGEMENT AND PHYSICAL REHAB DOCTOR FOR MANAGEMENT OF MY CARE. I STILL WANT TO DO MY ORTHOCARE FOLLOW UP WITH MY OS BUT FOR MY REHAB I WANT SOMEONE WHO WILL REALLY LISTEN TO ME, AND REALLY ANSWER MY QUESTIONS. I WAS OK WITH MY 1ST PT SESSION BUT YESTERDAY ON MY SECOND VISIT THE THERAPIST ASKED ME TO USE MY NONAFFECTED ARM TO LIFT MY AFFECTED ARM. I COMPLIED UP TO THE POINT WHERE THE PAIN WAS UNBEARABLE. HE THEN TOOK MY ARM AND FORCED IT TO THE POINT REPEATEDLY THAT I WAS CRYING AND GRIPPING A HOLE IN THE TABLE, BUT HE DID NOT STOP. ALL LAST NIGHT AND TODAY MY ARM HURT TOO MUCH TO DO THE EXERCISE AT ALL AND I AM BACK TO EXCESSIVE GUARDING. DO NOT GET ME WRONG I EXPECT PT TO HURT AND TO BE DIFFICULT BUT PAIN IS THE BODIES WAY OF TELLING US SOMETHING. I DO NOT WANT TO GO BACK TO A CENTER WHERE MY LIMITS ARE SO BRUTALLY FORCED. I HAVE A VERY HIGH TOLERANCE FOR PAIN. I HAD 4 KIDS NATURAL CHILD BIRTH. I ALSO CONTINUED TO WORK FOR 2 MONTHS WITH THIS BAD SLAP TEAR WHICH BY THE WAY TOOK 5 ANCHORS TO REPAIR. I DO NO WANT TO DAMAGE WHAT HAS BEEN CORRECTED BY SURGERY. I WANT TO WORK HARD IN THERAPY AND IN MY HOME EXERCISES WITHOUT FURTHER INJURY OR BEING SUBJETED TO UNREASONABLE PAIN. I THINK THIS IS RESONABLE. I KNOW I HAVE TO PUSH IT BUT FORCING MY ARM UP ABOVE MY HEAD AND GRABING MY ARM BY THE CUFF AND FORCEFULLY ROTATING IT VERY AGGRESSIVELY IS TOO MUCH. AMI WRONG. ANY ONE KNOW OF A GOOD PMR IN DALLAS OR SURROUNDING AREAS?

Trellis, I understand your frustration at not being heard.
Your OS could have anticipated much better the extent of your surgery and the laxity if he had listened to you. In regards to PT there are really 2 types of PT's. The first type knows they have to get your range of motion and come hell or high water they will get you there with no regard to your pain. The second type will be more gentle and try to work the muscles a little before assisting your arm into a new range. I am a PT, one of the second type and demand this of the therapist that is working on my arm. Given that you did not establish a good relationship with this therapist and that he is of the first type, I suggest you find another clinic and ask to work with the senior therapist, one who is familiar with shoulders.

At only 11 days post-op they should not have to be so aggressive. I was ranging my shoulder per my OS instructions 5 times a day with pendulums and assisted cane exercises from right after surgery. I did not let it get stiff and waited to see the therapist at 3 weeks. On this first session he worked the muscles in the back of the shoulder that were so tight from wearing the brace, then I was able to use the good arm to help the other while lying on my back. Most of the stiffness early on is from protective muscle spasms. What you are trying to prevent is joint contractures and scar tissue from forming beyond the sutures. There was no forcing or pushing me. There is a point after surgery say 5-6 weeks that more aggressive ranging should be done if you have failed to reach some acceptable ranges, but the most important thing is that you are comfortable with and trust your therapist. I hope this gives you a little perspective and encourages you to find the right PT. Sharon