Shoulder Arthroscopic Subacromial Decompression
Post Op Protocol
Confirm only Subacromial Decompression Performed
Ensure no Rotator Cuff Repair or Biceps Tenodesis
If Cuff Repair follow RCR Protocol
If tenodesis no biceps contraction for 6 wks
Immediately Post-Op
- In hospital ICE / cryo-cuff every 2-3 hours
- Do not put up with pain
- If no contraindications use this pain relief regime
- 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
- Sling for comfort only
- Aggressive pendulum exercises
(Forwards/Backwards)(Left/Right)
- Hand, wrist, elbow ROM as tolerated
- Protect Biceps if Tenodesis performed
- Support Elbow
- No active contraction of biceps
- Scapula exercises (shrugs, protaction, retraction, rolls)
- As frequently as tolerated
- Wall walking as tolerated
Weeks 1 to 2
- Continue exercises above
- Wean off Targin and Endone after first week
- No sling required
- Aggressive Pendular movements
- AROM (Active Range of Motion)
- PROM (Passive Range of Motion)
- PROM aggressively into FE every 2 hours min 20 Reps
- Table slides into FE as tolerated min 20 Reps
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 with arm at side min 20 Reps
- Internal rotation up behind back min 20 Reps
- Assisted AROM includes "wall walking" for FE
- Warm-up before exercises
- Walk for 1 minutes
- Warmth to shoulder (warm pack or warm shower)
- ICE after exercises for 30 mins
- Start gentle theraband work on all RC musles
- 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 3 to 4
- Continue above exercises
- Push PROM to achieve FROM (Full Range of Motion)
- Begin Gym program
- May start running and pool work
- Progress from gentle breastroke to freestyle swimming
Weeks 5 to 6
- If significant stiffness or pain at 6 wks may consider corticosteroid injection
- Start heavy work at 6 weeks
- Return to full contact sport at 6 weeks if tolerated