Latarjet Shoulder Surgery: Postoperative Care and Rehabilitation

Purpose and why it matters: Opening and closing the hand supports circulation and helps manage finger swelling without requiring movement at the shoulder joint.

Phase and start criteria: Begin on the day of surgery once you are alert and have enough hand sensation to hold the ball safely; do not exercise a completely numb hand.

Equipment and environmental safety: Use a very soft foam ball. Support the forearm on a pillow or inside the sling, and use a ball large enough that it cannot disappear between the fingers.

Starting position: Sit or recline with the operated upper arm beside the trunk and the entire forearm supported on a pillow or inside the sling; keep the wrist aligned with the forearm.

1. Relax the shoulder and neck.
2. Hold the ball gently with all the fingers.
3. Squeeze only until you feel light pressure.
4. Pause briefly without lifting the shoulder.
5. Open the fingers slowly and relax the hand fully.

Range, side, and limits: Only the hand on the operated side works; maximal squeezing, shoulder movement, and prolonged holds are prohibited.

Breathing, speed, and rhythm: Breathe out while squeezing, squeeze gently for two seconds, and release for two seconds; do not hold your breath. Documented dose: 10 to 20 repetitions, twice daily, following the early circulation-movement pattern in the Aarhus guidance. Rest: After every five repetitions, relax the hand completely for a few seconds.

Signs of correct performance: Only the fingers close; the shoulder and elbow do not move. Expected response: Mild palm fatigue should ease when you release the ball.

Stop immediately if: sharp shoulder pain, increasing numbness, cold fingers, or blue discolouration develops. Common errors: Using a firm ball, squeezing maximally, shrugging the shoulder, or holding the breath.

Easier version or regression: Make a half-fist without a ball. Progression criteria: Complete 20 repetitions without swelling or shoulder movement; do not add resistance yet. Next step: Add supported elbow and wrist movement in this phase only while the arm is fully supported.

Purpose and why it matters: Moving the joints below the shoulder reduces elbow and wrist stiffness and helps preserve hand function while you are using the sling.

Phase and start criteria: Begin on the day of surgery after sensation and control return. Active elbow flexion is allowed only when no biceps restriction is recorded on your instructions.

Equipment and environmental safety: Use a stable chair or bed and a pillow. When taking the forearm out of the sling, let the unoperated hand support all of its weight.

Starting position: Keep the upper arm against the trunk and still, the elbow supported, the forearm in front of the body, and the wrist free.

1. Place the entire forearm on the pillow and keep the unoperated hand ready to support it.
2. Move the wrist gently up and down.
3. Bend the elbow on the pillow without moving the upper arm.
4. If the biceps is restricted, let the unoperated hand guide the entire elbow movement.
5. Straighten the elbow slowly and return the forearm to the sling.

Range, side, and limits: Move only to a comfortable stretch; no weights, forced palm rotation, or movement of the elbow away from the trunk.

Breathing, speed, and rhythm: Move slowly with free breathing and do not force a pause at end range. Documented dose: 10 wrist repetitions and 10 to 20 elbow repetitions, twice daily, within the early-motion range in the Aarhus guidance. Rest: When the forearm tires, place it on the pillow and rest for one minute.

Signs of correct performance: The shoulder and upper arm stay still while only the forearm and wrist move. Expected response: A gentle elbow stretch should settle when the movement ends.

Stop immediately if: pain develops at the front of the shoulder, a deep pulling sensation occurs, numbness increases, or the upper arm moves unintentionally. Common errors: Letting the arm hang, using a weight, or using the shoulder itself to assist.

Easier version or regression: Shorten the range and let the unoperated hand guide the full movement. Progression criteria: Smooth elbow and wrist movement without increased symptoms—not added resistance. Next step: Once supported sitting is tolerated, add gentle scapular setting.

Expected and unwanted responses: Mild hand fatigue and a gentle elbow stretch should settle with rest; coldness, colour change, rapid swelling, or shoulder pain means you should stop.

Do not: open the sling without supporting the arm, move the shoulder actively, lift an object, bear weight through the palm, or exercise while dizzy or while the hand is fully numb.

Criteria to advance: Medicines and the sling are being managed correctly, hand movement causes no neurovascular symptom, and pain returns to baseline before the next session.

Purpose and why it matters: Gentle activation of the muscles around the shoulder blade helps maintain trunk posture while the bone transfer and shoulder joint remain protected.

Phase and start criteria: Begin on day 4 when sitting with the operated forearm supported in the sling or on a support does not increase wound pain.

Equipment and environmental safety: Use a chair with a back and a correctly fitted sling or one pillow; the operated arm must not hang.

Starting position: Keep the trunk upright and neck relaxed, with the right forearm supported in the sling and the left arm relaxed beside the body.

1. Breathe gently and relax the shoulders.
2. Move the right shoulder blade only a very small distance toward the spine.
3. At the same time, keep it slightly down.
4. Hold for three seconds without moving the right arm backward.
5. Return slowly to the resting position.

Range, side, and limits: The movement is small and occurs only at the right shoulder blade; do not force the chest forward or move the elbow behind the trunk.

Breathing, speed, and rhythm: Breathe out while setting the shoulder blades, hold gently for three seconds, and return without suddenly releasing. Documented dose: 5 to 10 repetitions, twice daily, following the early-exercise pattern in the Aarhus guidance. Rest: Relax the shoulder blades fully and take several normal breaths between repetitions.

Signs of correct performance: The muscles between the inner border of the right shoulder blade and the spine become active, but the shoulder does not rise. Expected response: Mild activity behind the shoulder blade without pulling at the front of the shoulder.

Stop immediately if: deep pain, pulling at the wound, or new numbness develops. Common errors: Arching the back, squeezing too hard, or pulling the arm backward.

Easier version or regression: Simply straighten the trunk and make the scapular movement smaller. Progression criteria: Complete 10 repetitions with a stable posture and no overnight reaction. Next step: Add the scapular clock only after this movement is tolerated without moving the arm.

Purpose and why it matters: In the first days the shoulder must not work on its own, but complete stillness stiffens the joint. Here the good hand carries the entire weight of the arm and the operated shoulder simply rides along, so the path of elevation returns sooner without any pull reaching the transferred bone or the repair at the front of the shoulder.

Phase and start criteria: From day four, and only once the nerve block has completely worn off and sensation and control have returned to the hand; the North Tees guide starts the home programme at exactly this point and notes it usually takes 12 to 48 hours. Before the first repetition, the height you are allowed must be written on your discharge sheet or individual plan; if it is not written, ask, and do not start until it is.

Equipment and environmental safety: A bed or a firm, flat surface and a thin pillow under the head; nothing else is needed, and no wand is used in this exercise. The sling is opened with help from the good hand before the exercise and closed again immediately afterwards. Do not do this on a soft sofa or a springy bed; the surface must hold the arm still.

Starting position: On your back, knees bent and feet flat on the bed, the right arm beside the trunk and the right elbow bent; the left palm cups the right elbow from underneath and carries all of its weight. The right wrist is relaxed and the forearm rests on the abdomen.

1. Take a few calm breaths and let the muscles at the front of the right shoulder go completely soft.
2. Cup the right elbow from underneath with the left hand so the right arm bears no load at all.
3. Using the strength of the left hand, lift the elbow gently off the chest and up towards the ceiling.
4. Stop exactly at your written height limit and pause for one to two seconds, with no stretch at the end.
5. With the same control from the left hand, lower the arm slowly back beside the trunk and take a breath before the next repetition.

Range, side, and limits: Only to the height your surgeon has set, and only on the right. The right elbow stays bent throughout — this "short lever" is what keeps the load off the front of the shoulder. The arm does not travel out to the side away from the body line, does not go behind the trunk, and no external rotation is performed in this exercise.

Breathing, speed, and rhythm: Breathe out as the arm rises, count two seconds up and two seconds down, and do not hold your breath.

Documented dose: 10 repetitions, one minute of rest, then 10 more; three times a day (North Tees stage 1 guide).

Rest: A full minute between the two sets; if you tire, rest the arm in the sling and postpone the next session.

Signs of correct performance: The muscles at the front of the right shoulder stay slack, and if you let go with the left hand mid-way the right arm does not hold itself up.

Expected response: A very mild stretch at the front of the shoulder that settles as the arm comes down.

Stop immediately if: Sharp or burning pain at the front of the shoulder, a sense of shifting or looseness, pulling along the wound line, new pins and needles, or increased night pain.

Common mistakes: Helping with the operated shoulder itself, going past the written height because "it does not hurt", straightening the right elbow mid-movement, and shrugging the shoulder towards the ear.

Easier version or regression: Halve the height, or drop to 5 repetitions.

Progression criteria: Two sets of 10 within the permitted height, without sharp pain and with no reaction by the next morning.

Next stage: The long-lever, two-direction version of this same movement in week two, only after this exercise is fully tolerated.

Purpose and why it matters: Two simple directions—very slight elevation and gentle movement toward the spine—limit shoulder-girdle stiffness without actively lifting the arm.

Phase and start criteria: Begin in week 2 when the previous days’ scapular setting is pain-free and your discharge plan does not prohibit scapular movement.

Equipment and environmental safety: Use a stable table at elbow height. Keep the right forearm fully supported on the table and the left arm relaxed beside the body.

Starting position: Stand in a posterior three-quarter position with the trunk upright, neck relaxed, right elbow supported on the table, and the arm inactive.

1. Lift the operated shoulder only a few millimetres without bringing it toward the ear.
2. Return gently to the resting position.
3. Then move the shoulder blade very gently toward the spine.
4. Pause for two seconds without moving the elbow backward.
5. Relax the shoulder blade fully and continue breathing normally.

Range, side, and limits: The movement is small and occurs only at the shoulder blade; forceful shrugging, trunk rotation, and active arm movement are prohibited.

Breathing, speed, and rhythm: Perform each direction smoothly and slowly, and breathe out while drawing the shoulder blade inward; quality matters more than speed. Documented dose: Five cycles, twice daily, within the 5-to-10-repetition range of the early Aarhus programme. Rest: Relax the shoulder blade and take several slow breaths between cycles.

Signs of correct performance: A subtle change in scapular position is visible, but the hand and elbow stay in place. Expected response: A mild stretch at the back of the shoulder should settle quickly.

Stop immediately if: pain at the front of the shoulder, pulling at the wound, new tingling, or arm movement occurs. Common errors: Shrugging toward the ear, using a large range, or pulling the elbow backward.

Easier version or regression: Practise only one direction with a smaller range. Progression criteria: Five calm cycles without compensation or a next-day reaction. Next step: Begin the assisted table slide only after entering week 3 and meeting the next phase’s criteria.

Purpose and why it matters: The shoulder rises along two different paths: forward, and out to the side. Train only one and the other stays stiff, and everyday tasks such as dressing or reaching a shelf become hard later. This exercise keeps both paths open in one session and entirely under the power of the good hand; compared with the day 4–7 exercise, the good hand now holds the forearm and wrist instead of the elbow, which lengthens the lever.

Phase and start criteria: From week two, and only once the short-lever version (holding under the elbow) tolerates two sets of 10 without sharp pain and without a reaction the next morning. For the first three weeks the Aarhus guide permits passive and guided movement "within pain limits and in all directions except external rotation combined with abduction", and says to move to the point of stiffness, not to pain.

Equipment and environmental safety: A bed or a firm, flat surface and a thin pillow under the head. The sling is opened before the exercise and closed immediately afterwards. Both directions are done lying on your back so that if the good hand loses control for a moment the arm settles onto the bed instead of dropping.

Starting position: On your back, knees bent and feet flat on the bed. The right arm beside the trunk, the right elbow almost straight and the right palm facing the trunk. The left hand grips the right forearm from underneath, near the wrist, and carries all of its weight.

1. Take a few calm breaths, release the right shoulder, and make sure the left hand has taken the whole weight of the arm.
2. First direction — forward (flexion): using the left hand, raise the right arm along the line of the body towards the ceiling, stop exactly at the written limit, pause for one to two seconds, and lower it slowly.
3. Complete all the repetitions of the first direction, then rest the arm beside the trunk.
4. Second direction — to the side (abduction in the plane of the scapula): now raise the arm with the left hand not in a straight sideways line but about 30 degrees forward of the side — that is, in the plane the shoulder blade sits in.
5. Throughout the second direction the right palm must stay facing the trunk; do not let the forearm rotate outwards. The height limit is the same written limit.
6. Pause for one to two seconds and return the arm to the trunk with the same control.

Range, side, and limits: Both directions only to your own written limit and only on the right. The most important restriction in this exercise: raising the arm to the side must not be combined with external rotation; that combination is exactly the position Aarhus excludes in the first three weeks, and in a Latarjet it puts the greatest pull on the repair at the front of the shoulder. The arm does not go behind the trunk, and the right arm never works for itself at any moment.

Breathing, speed, and rhythm: Breathe out as the arm rises, and perform each direction counting two seconds up and two seconds down.

Documented dose: For each direction, 10 repetitions, one minute of rest, then 10 more; three times a day, continuing the same North Tees stage 1 pattern. If both directions together tire you, do the forward direction in the morning and the sideways one in the afternoon.

Rest: A full minute between sets and between the two directions.

Signs of correct performance: The right arm is slack in both directions and drops if the left hand lets go; in the sideways direction the right palm faces the trunk all the way through.

Expected response: A mild stretch at the front of the shoulder in the forward direction and a mild stretch over the top of the shoulder in the sideways one, both settling as the arm comes down.

Stop immediately if: Sharp pain at the front of the shoulder, a sense of shifting or looseness, new pins and needles in the hand, pulling along the wound line, or increased night pain.

Common mistakes: Turning the palm outwards in the sideways direction (that is the forbidden combination), taking the arm into a fully sideways line instead of the scapular plane, the right arm quietly switching on to help the left, and shrugging the shoulder towards the ear.

Easier version or regression: Do only the forward direction and postpone the sideways one by a week, or go back to the short-lever version from days 4 to 7.

Progression criteria: Both directions within the permitted limit, fully controlled by the good hand and with no reaction by the next morning.

Next stage: Wand-assisted movement and then active movement, each only with the permission that belongs to its own stage.

Purpose and why it matters: Here the shoulder does no work at all; the feet create the movement. As you step back from the table, the hands stay where they are and the shoulder opens gently with no muscular effort. For a patient who does not yet trust raising the arm, this is the safest way to train that same path.

Phase and start criteria: From week two, once you can stand without dizziness and the lying-down assisted exercises are free of sharp pain. The North Tees stage 1 guide includes this movement in its home programme.

Equipment and environmental safety: A tall, solid table roughly at waist height, a non-slip floor and closed-heel shoes. The table must not have wheels or shift when pushed. The key safety point: the hands only rest, and body weight stays over the feet — bearing weight through the palm is not allowed in this period.

Starting position: Standing facing the table and close against it, both palms on the table top, elbows almost straight, trunk upright and shoulders down and relaxed.

1. Place both palms on the table and make sure it does not move.
2. Step backwards slowly with small steps and let the trunk come down.
3. Go back only as far as a comfortable stretch, never pain.
4. Hold that point for one to two seconds without pressing the palms into the table.
5. Take small steps forward until you are standing upright beside the table again.

Range, side, and limits: The further back you step the more the shoulder opens, so how far you step back IS your range limit; do not go beyond the written one. Do not drop your head between your arms, do not arch the low back, and do not push down through the hands.

Breathing, speed, and rhythm: Breathe out as you step back, and make the movement with small continuous steps rather than one jump backwards.

Documented dose: 10 repetitions, one minute of rest, then 10 more; three times a day (North Tees stage 1 guide).

Rest: A full minute between the two sets, seated.

Signs of correct performance: You feel the stretch at the front of the shoulder and under the arm, and body weight stays over the feet rather than on the hands.

Expected response: A mild stretch that disappears the moment you stand upright.

Stop immediately if: Sharp pain at the front of the shoulder, a feeling of instability, dizziness, a foot slipping, or the table moving.

Common mistakes: Dropping body weight onto the palms, stepping too far back in the first session, lifting the operated hand off the table mid-movement, and doing the exercise on a low table that bends the back.

Easier version or regression: Take only two small steps back, or start with the forearms resting on the table.

Progression criteria: Stepping further back in the same number of steps, without pain and without the trunk position deteriorating.

Next stage: Wand-assisted movement in week four, and then upright active elevation in month two.

Expected and unwanted responses: Greater awareness of scapular position is expected; sharp pain or unintended arm movement calls for regression.

Do not: perform pendulums or shoulder-joint movement that has not been cleared on your instructions, actively lift the hand, stretch external rotation, or reach behind the back.

Criteria to advance: Scapular movement is pain-free, has no shrugging, and does not increase symptoms by the next morning.

Purpose and why it matters: Trunk movement and a sliding surface carry the arm gently forward so range can return without actively lifting the shoulder.

Phase and start criteria: Begin in week 3 when the wound is settled, pain is manageable, and assisted motion is allowed in your individual programme.

Equipment and environmental safety: Use a sturdy table, a chair without wheels, and a towel. Keep the entire operated forearm on the towel.

Starting position: Sit facing the table with the trunk upright, the elbow and forearm on the towel, and the shoulder low and relaxed.

1. Rest the unoperated hand on the thigh so it does not push the operated arm.
2. Move the trunk slowly forward so the towel slides.
3. Stop at the first comfortable stretch.
4. Pause for one to two seconds without pressing through the palm.
5. Return to the start by moving the trunk backward.

Range, side, and limits: Flex only to the written limit and do not force external rotation; the operated hand does not push the table.

Breathing, speed, and rhythm: Breathe out as you move forward and keep the forearm moving slowly on the towel in both directions. Documented dose: 5 to 10 repetitions, twice daily, following the conservative early-exercise pattern in the Aarhus guidance. Rest: Pause for a few seconds between repetitions and, if tired, rest for one minute.

Signs of correct performance: The forearm glides continuously on the table and the shoulder does not rise. Expected response: A gentle stretch should settle after you return.

Stop immediately if: catching, a sense of instability, sharp pain, or obvious trunk compensation occurs. Common errors: Actively pressing with the hand, forcing the reach, or lifting the forearm off the towel.

Easier version or regression: Shorten the slide and move the chair closer to the table. Progression criteria: Range increases gradually without pain or loss of form through the next day. Next step: Add wand-assisted elevation after this path is controlled and you enter week 4.

Purpose and why it matters: The unoperated hand guides the weight of the wand and operated arm so the flexion path can be practised without early shoulder activation.

Phase and start criteria: Begin in week 4 after assisted motion is permitted and you can perform the table slide without sharp pain or compensation.

Equipment and environmental safety: Use a firm, flat bed and a lightweight wand. A three-quarter viewing angle lets you see both hands and the wand’s path.

Starting position: Lie on your back with the elbows relaxed, both hands on the wand, and the operated arm close to the trunk.

1. Relax the operated shoulder.
2. Use the unoperated hand to guide the wand gently toward the ceiling.
3. Continue only to the range written in your programme.
4. Pause briefly without stretching at end range.
5. Use the unoperated hand to lower the wand and arm under control.

Range, side, and limits: The operated arm remains passive; do not arch the back or force additional range.

Breathing, speed, and rhythm: Breathe out as the arms rise and move slowly in both directions under the control of the unoperated hand. Documented dose: 5 to 10 repetitions, twice daily, following the conservative Aarhus pattern. Rest: Pause for 30 to 60 seconds after five repetitions.

Signs of correct performance: The unoperated hand controls a smooth path and the operated shoulder does not jump upward. Expected response: A brief, mild stretch that eases after lowering.

Stop immediately if: pain at the front of the shoulder, a shifting sensation, or increasing night pain develops. Common errors: Pulling with the operated arm, arching the back, or forcing end range.

Easier version or regression: Reduce the range and repetitions or return to the table slide. Progression criteria: Smooth range with no next-day reaction. Next step: Begin active supine movement only after active motion is explicitly permitted in month 2.