Arthroscopic Shoulder Stabilisation
Post Op Protocol
The Operative Notes should accompany you on discharge in a folder with other documents including your physio referral. PLEASE give this information to the physio to individualise your rehab.
Also NOTE if a BICEPS TENODESIS was performed!!
Day 1 to day 7
- In hospital ICE / cryo-cuff every 2-3 hours
- Do not put up with pain!! Ensure you take adequate pain relief
- You may need to seeyour GP for additional medication or contact Dr Maguire's Rooms
- If no contraindications use this pain relief regime
- PCA overnight then change to the following in am:
- Paracetamol 1gram four times a day
- Ibuprofen 400mg three times a day
- 10 to 20 mg of TARGIN (Oxycontin) twice a day
- 5-10 mg of Endone as required up to 3 hourly
- Ensure Fluid intake and bowel softening agents
- Prevent constipation from Endone/Targin
- Remain in sling unless doing physio or showering or if doing simple activity
- MUST wear sling to bed!!!
- Gentle pendulum exercises
(Forwards/Backwards)(Left/Right)
- Hand, wrist, elbow ROM (Range of Motion) as tolerated
- External rotation to neutral (0 Degrees only)
- Protect Biceps if Tenodesis performed
- Support Elbow
- No active contraction of biceps
- Scapula exercises (shrugs, protaction, retraction, rolls)
- As frequently as tolerated
- Maintain cardiovascular exercise after Day 3 may start walking, stationary bike
Weeks 2 to 6
- Continue exercises above
- Wean off Targin and Endone after first week. (Try to stop Targin after a few days and just take Endone when needed)
- Continue Panadol and Neurofen if no contraindications (Ask GP if not sure)
- Abduction sling on unless showering, eating or sitting
- Sling ALWAYS on for sleeping and when mobilising
- Remain in sling unless doing physio or showering or if doing simple activity
- MUST wear sling to bed!!!
- Gentle Pendular movements (Assisted)
- PROM (Passive Range of Motion) only!
- PROM Supine FE gently up to 140 (only 10 reps max)
- Table slides into FE as tolerated (only 10 reps max)
Figure 1. Table slide. (A) Starting position. While seated at a table, the patient places the hand of the affected shoulder on a sliding surface (e.g., a magazine that slides over a smooth table surface). (B) Ending position. The patient slides the hand forward, maintaining contact with the table, while the head and chest advance toward the table.
- External Rotation (ER) to 30 degrees (only 10 reps max)
- If large subscapularis tear ER to neutral till wk 6
- Internal rotation to buttock (only 10 reps max)
- Warm-up before exercises
- Walk for 1 minutes
- Warmth to shoulder (warm pack or warm shower)
- ICE after exercises for 30 mins
- Gentle isometric contractions of Rotator Cuff
- Start gentle theraband work if no rotator cuff repair
- Use core muscle exercises and lower limb exercises from Day 1 post Op
- e.g. Kibler Kinetic Chain Theory
- Protect Biceps if Tenodesis performed
- Support Elbow
- No active contraction of biceps
- Aerobic exercise (walking or stationary exercise bike)
Weeks 7 to 8
- Continue above exercises
- Discontinue sling after 6 wks and perform normal ADL's (Activities of Daily Living)
- Begin Assisted AROM at 7wks (Unless Rotator Cuff Tear)
- Assisted AROM includes "wall walking" for FE
- Push PROM to achieve FROM (Full Range of Motion)
- Start gentle theraband work 2 wks after Assisted AROM
- Only for cuff muscles not repaired
- e.g. Medium Tear at 10 wks
- Continue theraband work if no rotator cuff repair
- Continue cardiovascular conditioning
- Continue hand, wrist, elbow exercises
- Core strengthening especially transversus abdominis, multifidus
- Scapular mobilization / proprioception
- Avoid full abduction and external rotation as this may disrupt repair
Weeks 9 to 12
- Continue above exercises
- Begin Gym program
- May start running and pool work
- Progress from gentle breastroke to freestyle
- Avoid heavy lifting for 3 months
- Lift with arms close to body
- This avoids the "Lever Arm Effect"
- If significant stiffness or pain at 12 wks may consider corticosteroid injection
At 3 months
- Start capsular stretches
- Continue cuff strengthening
- Start formal gym program
- Advance cardiovascular conditioning
- Core strengthening
- Continue scapular mobilization / proprioception
- May consider return to contact sport or heavy manula labour at 4 months in shoulder brace
- Most patients return to sport at 6+ months
6 months to 12 months
- If stiffness persists for 12 months may consider arthroscopic capsular release