Arthroscopic Shoulder Decompression/Acromioplasty Rehabilitation Protocol

PHASE I – IMMEDIATE MOTION PHASE (0-2 WEEKS)

GOALS:

  • Proper healing of surgical incisions.
  • Pain and edema control.
  • Prevent effects of immobilization.
  • Full, pain-free ROM.
  • Prevent atrophy

RESTRICTIONS:

  • Avoid external rotation at 45 degrees and above
  • Avoid overhead work or sports until minimal pain
  • Avoid lifting, pushing, pulling 1-2 weeks post-op
  • Avoid leaning on elbow.
  • Sling may be removed in 1-2 days except for driving.

INTERVENTIONS:

    • Wear sling for first 2 day.
    • Monitor healing of incisions.
    • Instruct in HEP.
    • Discuss goals of treatment with patient.
    • PROM and AAROM exercises (all planes)
      a. Pendulum
      b. Cane
      i. flexion/extension
      ii. Abduction/Adduction
      iii. ER/IR (start a 0 abduction, progress to 45, then 90)

c. Rope and Pulley

d. Wall Walking

  • Strengthening
    a. Incorporate forearm, wrist, and hand exercises first day post-op
    b. Sub-maximal isometrics (all planes)
  • Posterior capsule stretches (horizontal adduction in sitting)
  • Self stretches for flexion
  • Modalities for pain control (cryotherapy and electrical stimulation)

PHASE 2 – INTERMEDIATE PHASE (2-6 WEEKS)

GOALS:

  • Normalize full ROM.
  • Regain and improve strength to 4/5
  • Improve neuromuscular control
  • Eliminate pain and edema

INTERVENTION:
Continue with phase I exercises with the following modifications/additions:

  • AROM
  • Aggressive stretching
  • Strengthening
    a. Isotonic dumbbell program of all shoulder and scapulo-thoracic muscles
    b. UBE
  • Joint mobilization as needed
  • PNF
    a. Weight shifting in quadruped
    b. Rhythmic stabilization

PHASE 3 – DYNAMIC STRENGTHENING PHASE (6-12 WEEKS)

GOALS:

  • Full, pain-free ROM
  • No pain or tenderness
  • Strength 70% of uninvolved side
  • Improve strength, power, and endurance
  • Improve neuromuscular control
  • Prepare patient for gradual return to previous level of functional activity.

INTERVENTIONS:
Continue with Phase 2 exercises with the following modifications/additions:

  • Strengthening
    a. Theraband exercises
    b. Plyometric exercises for rotator cuff
    c. Apply manual resistance to PNF patterns
  • Advanced proprioception stabilization activities

PHASE 4 – RETURN TO ACTIVITY PHASE (12-16 WEEKS)

GOALS:

  • Unrestricted activity
  • Maintain normal function and motion
  • Strength 85% of uninvolved side

INTERVENTION:

  • Initiate interval program