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Subacromial Decompression - Physical Therapy Protocol


(Neer Acromioplasty) and Distal Clavicle Resection (Mumford)

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Preoperative Guidelines

  • Restore full shoulder AROM
  • Strengthen in painfree ROM, emphasize rotator cuff/scapular stabilization musculature
  • Instruct in post-op protocol
  • Educate Patient on post-op compliance to ensure best functional outcome


Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.


**If the Mumford is an OPEN procedure, restrict overhead activities and heavy lifting for 3 weeks. Limit AROM to 90 degrees of flexion and abduction for 3 weeks. Use ice 20 mins, 3-5 times/day for first 5-7 days. After 3 weeks, progress per protocol


Phase I (Post-op Days 1-7)

  • Sling for comfort 1-2 days PRN
  • Hand squeezing exercises, Elbow and Wrist AROM
  • Submaximal isometrics all planes…progress to light tubing as tolerated
  • Scapular mobilizations/ROM/shoulder shrugs
  • Pendulum exercises
  • Wand exercises (do not push into painful ROM): follow precautions above if open procedure
  • Pulley exercises (do not push into painful ROM): follow precautions above if open procedure
  • Ice 20 mins 3-5 times/day for the first week, then PRN after that


Goals: Control/reduce pain and inflammation, full elbow, hand and wrist ROM, 70% AROM


Phase II (when 70% ROM is met)

  • UBE forward and backward
  • Progress PROM/AAROM to tolerance
  • Posterior capsule and posterior rotator cuff stretching
  • Scapular strengthening exercises: shrugs/rows/retraction/push-outs (“punches”)
  • Progressive isotonics with Theraband, pulleys, free weights all directions
  • Dynamic stabilization exercises for scapula: weight shifting PNF, rhythmic stabilization, ball on wall, BAPS, Body Blade, Plyoback progression
  • Wall pushups….progress to table, then bent knees
  • Pool program for strengthening and ROM/stretching
  • Stationary bike, treadmill, jogging


Goals: Full AROM shoulder with normal scapulothoracic rhythm, shoulder strength at least 4+/5


Phase III (when Phase II goals are met)

  • Regular push-ups (but not before 2 months post-op)
  • Gym program (no bench press, no deep dips)
  • Gravitron (painless level)
  • Initiate sports-specific or work-specific drills/tasks (no overhead before 2 months post-op)
  • Throwing progression (no pitching before 2 months post-op)
  • May begin swimming progression


Goals: Normal pain free shoulder ROM and strength, normal arthrokinematics,

No sports until at least 2 months post-op

 

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