Acromioplasty Rehabilitation Protocol +/- Biceps Tenodesis +/- Capsular Release

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

  • If capsular release then range of motion (ROM) as tolerated begin day 1 – ROM is priority.

 

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 inter-scapular 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 inter-scapular 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 (Range as tolerated in Capsular Release cases)

  • 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). Scapulo-humeral rhythm control.

 

Phase 2 : From 2 weeks post-operatively onwards

Goals

Increase range of motion (free range of motion within pain limits), scapulo-humeral 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 scapulo-humeral 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 weeks 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 scapulo-humeral 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 Scapulo-humeral 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

Competitive sports after approximately 12 - 14 weeks as a baseline. Approximately 1 year to see 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.