Post-Operatively: SCHEDULED VISIT 10 DAYS AFTER SURGERY

1. Upper extremity assessment ROM and isometric strength.
2. Reinforce functional training education as listed above limiting active shoulder ROM to 90˚ abduction and flexion. Also limiting lifting, pushing, pulling activity.
3. Provide appropriate written therapeutic exercise program to maintain Range of Motion at home.
4. Provide lymphedema avoidance strategies and education if appropriate.
5. Encourage deep breathing utilizing full costly expansion.
6. Provide self shoulder mobilization techniques – limiting shoulder elevation to 90 degrees of elevation.

3-4 Weeks Post-Surgery

1. Cardio-vascular assessment.
2. Begin full active shoulder ROM exercises as well as shoulder stabilizations done isometrically and using light gauge elastic bands.
3. Begin graded upper trunk resistive exercises and generalized endurance training.
4. Provide mobilization techniques to both Gleno-Humeral and Scapulo-Thoracic joints if needed.
5. Provide education on gentle self-massage at Pectoralis border and also to include perimeter of breast area.
6. Re-institute lymphedema avoidance strategies. Assess with girth and volume measurement, if appropriate.

Discharge Treatment Goals

• Full Range of Motion in axial and Appendicular skeleton
• Posture - minimizing increased cervical spine kyphosis and shoulder protraction
• Manual strength grade of 4+/5 affected quadrant
• Balke Ware endurance test of level 11/15
• Proficiency in self massage of anterior chest wall
• Proficiency in Lymphedema avoidance strategies and practices
• Provide home exercise program and have participant proficient in independent exercising to maintain flexibility, strength and endurance.