Rehabilitation after ligamentous and labral surgery of the shoulder: guiding concepts.

OBJECTIVE: To provide treatment guidelines for rehabilitation after ligamentous and labral surgery of the shoulder. DATA SOURCES: We searched Index Medicus for the last 10 years using the key words "shoulder instability," "shoulder exercises," and "shoulder surgery." DATA SYNTHESIS: Detailed rehabilitation programs for patients with anterior shoulder instability reconstructions can be found in the literature, but many are based on anecdotal evidence and clinical observation. Randomized, prospective outcome studies on these rehabilitation protocols have not been performed. Therefore, we offer a performance- and criteria-based guideline for rehabilitation that is rooted in basic science, surgeons' recommendations, clinical experience, and common sense. CONCLUSIONS/RECOMMENDATIONS: To return an athlete to the preinjury level of function, range of motion, strengthening, proprioception, and functional activities must be used judiciously, keeping healing constraints and arthrokinematics in mind.