Arthroscopic Distal Clavicle Resection Rehabilitation Protocol

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 2 weeks for wound healing.

  • Come out of sling for regular exercises from day 1.

  • Shoulder abduction and flexion as tolerated from day 1

  • No strength training or heavy lifting for minimum 2 weeks postoperatively

  • Gradual return to sporting activity from 6 weeks post operatively

  • May drive again when out of sling and comfortable

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 range of motion exercises initially within comfort but no 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 8 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 post-operatively

Goal

Focus on gentle range of motion, good circulation, and posture

Action

  • Daily active exercises. Care to work within pain limitations. Pendular exercises. Active elbow flexion (Passive if biceps tenotomy / tenodesis) and extension, hand circulation exercises and scapular muscle activation.

  • Passive and active range of motion exercises within pain limitations.

  • Avoid strength training during this phase.

  • 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 tolerated. Scapulohumeral rhythm control.

 

Phase 2 : From 2 - 6 weeks post-operatively

Goals

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

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 2: check for good scapulohumeral rhythm

  • Can begin focused joint stretching and mobilisation from week 4 if range of motion is not optimal

  • Can gradually incorporate increase In isometric loading, concentric and eccentric rotator cuff and general strength exercises

  • Avoid shoulder press, bench press and similar activities in this phase.

  • No contact sport in this phase.

  • Aim for full range of motion by week 6 post operatively.

Criteria to enter phase 3

  • Full range of motion with good quality range of motion, little or no pain, good scapulohumeral rhythm. Good strength of rotator cuff and general shoulder girdle strength. Aim for 90% of contralateral shoulder

Phase 3: From 6 weeks onwards

Goals

Return to work and normalise ADLs and work practices

Action

  • ADLs, work and sports specific training

  • Can begin bench press and shoulder press, lateral raise, and similar training

  • Increase muscle strength, power, and stamina

  • Maintain full range of motion

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