Acromioplasty Rehabilitation Protocol +/- Biceps Tenodesis

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 4 weeks.

  • Sling for 6 weeks if biceps tenodesis.

  • Come out of sling for regular exercises.

  • Shoulder abduction and flexion to maximum 60 degrees, external rotation to 20 degrees in the first 2 weeks post operatively

  • No strength training or heavy lifting for minimum 6 weeks postoperatively

  • Gradual return to sporting activity at 8 – 12 weeks

  • If biceps tenodesis / tenotomy no biceps / shoulder flexion loading for 8 weeks.

    • Avoid extension of elbow and shoulder in combination

 

Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home

Aim to get early control of shoulder girdle and interscapular muscles

Light pendular and rotation exercises within range of motion limits

Circulation exercises

Do exercises 6 x per day

Aim for a relaxed exercises to avoid tension about the shoulder and neck

 

At 2 and 6 week follow up

  • Wound review

  • Check pain levels

  • Observe simple ADLs

  • Range of motion in flexion, abduction and rotation should be measured

  • Check control of shoulder girdle and interscapular muscles

 

Phase 1: 0 - 2 weeks

Goal

Focus on gentle range of motion, good circulation and posture

Action

  • Daily active exercises. Careful pendular exercises. Active elbow flexion (Passive if biceps tenotomy / tenodesis) and extension, hand circulation exercises and scapular muscle activation.

  • Passive range of motion exercises with limits: abduction 60 degrees, flexion 60 degrees and external rotation 20 degrees

  • Use of cooling therapies for swelling reduction

  • Relaxation and posture exercises to reduce tension in the neck and shoulder girdle 

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve range of motion as stipulated above (60/60/20). Scapulohumeral rhythm control.

 

Phase 2 : From 2 weeks post-operatively onwards

Goals

Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature

Action

  • Passive and active assisted scapular range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion

  • Scapular mobility exercises

  • Begin light isometric rotator cuff strength with flexed elbow.

  • Active theraband exercises from week 4 - 6: check for good scapulohumeral rhythm

  • Can begin focused joint stretching and mobilisation from week 8 if range of motion is not optimal

  • Can gradually incorporate increase in isometric loading and concentric rotator cuff exercises

  • Aim for full range of motion by week 6 – 8 post operatively. Can take up to 12 weeks

Criteria to enter phase 3

  • Over shoulder height range of motion with good quality range of motion, little or no pain, good scapulohumeral rhythm.

Phase 3: From week 8 onwards

Action

  • Aim for normal active and passive range of motion

  • Functional training

  • Biceps loading to start 

Criteria for moving to next phase

  • Full active range of motion. Little to no pain, good scapulohumeral rhythm and muscular control.

Phase 4: From week 8 onwards

Goals

Return to work and normalise ADLs and work practices

Action

  • ADLs, work, and sports specific training

  • Increase muscle strength, power, and stamina

  • Maintain full range of motion

Timeframes

Light activities from 8 weeks. Sports from generally 12 weeks onwards. Approximately 1 year for continued improvements in function.

Criteria for return to sport

  • Full range of motion. No pain with activity. Good muscular control.

  • Strength test 90% compared to uninjured side. 95% for contact and throwing.

  • Constant score > 90% compared to uninjured side.