Aim of surgery: To relieve symptoms of sub-acromial and acromioclavicular pain syndrome.
Expected long-term outcome: Patient reports a relatively pain free shoulder which facilitates return to normal functional activities. Some patients may continue to experience mild discomfort with repetitive or heavy tasks overhead. These may need to be modified. Some patients may not regain full range into combined rotation (hand behind back) position.
It may take 6-12 months for patients to realise their full potential following the above procedure.
Rehab Guidelines
Up to Week 2
Weeks 2 – 4
Weeks 4 – 6
Week 6
Milestones
Options if failure to achieve Milestones
Failure to progress
If a patient is failing to progress, then consider the following:
Possible Problem |
Action |
Pain Inhibition |
• Adequate analgesia
• Keep exercises pain-free
• Return to passive ROM if necessary until pain controlled
• Progressing too quickly – hold back
• If severe night pain/resting pain – refer to OP clinic
|
Patient exercising too vigorously or patient not doing home exercise programme (HEP) regularly enough |
• Increase or reduce physiotherapy/(HEP) (max 2-4x/day) for few days/weeks and assess difference
• Ensure HEP focuses on key exercises and link to function
|
Returned to activities too soon |
Decrease activity intensity |
Cervical/thoracic pain referral |
Assess and treat accordingly |
Unable to gain strength |
Passive ROM may need improving – need 90° passive flexion to start eccentric deltoid work |
Altered neuropathodynamics |
Assess and treat accordingly |
Poor rotator cuff control |
• Ensure passive range gained first
• Consider isometrics through range
• Rotation dissociation through range with decreasing support and increasing resistance
• Ensure not progressing through Therabands too quickly
|
Poor scapula control |
Work on scapula stability through range without fixing with pec major/lat dorsi |
Poor core stability |
Work on improving core stability |
Secondary frozen shoulder (more likely with RCR). |
Maintain passive ROM as able |