Arthroscopic Subacromial Decompression +/- ACJ resection Protocol

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

Discard polysling as soon as pain allows
Use arm as soon as comfortable
Active-assisted to active elevation, limit OKC elevation above shoulder height
Isometrics for rotator cuff
Pain restricting range of motion to no less than 75% of pre-op.

Weeks 2 – 4

Scapular exercises
Theraband rotator cuff strengthening
Minimize OKC elevation above shoulder height

Weeks 4 – 6

Progress strengthening and ROM to full OKC
Sport specific exercise when ROM allows and strength 90% of unaffected side
Capsular stretches if appropriate
No ROM restriction

Week 6

Range of motion equal to the pre-operative range of motion
Commence sport/repetitive overhead activities providing above goals achieved
Majority have discomfort for at least 3 months
Expected long term outcome may take 6-12 months to achieve

Milestones

Sling for comfort 1-2 days
Dressings removed 7-10 days post op
Driving when comfortable
Light work 3-4/52

Options if failure to achieve Milestones

Outpatient physiotherapy.
Hydrotherapy.
Referral to the OPD shoulder clinic
Return to pre op range of movement by 6/52
Heavy/manual work 6-8/52

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

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