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ARTHROSCOPIC
ACROMIOPLASTY PROTOCOL
Includes Treatment for:
Arthroscopic
Acromioclavicular (AC) Joint Excision
Arthroscopic Partial Thickness Rotator Cuff Debridement
|
Post Op |
Exercises |
|
0-1 Week |
Sling worn for comfort only
1.
Pendulum exercises 3x/day
minimum
2.
Elbow and wrist AROM 3x/day
minimum
3.
Cryocuff/ice: days 1-2 as
much as possible, then post activity or for
pain
|
|
1-2 Weeks |
ADL’s (activities
of daily living) within pain tolerance,
avoiding impingement
1. Passive range of
motion (PROM) and active-assisted range of
motion (AAROM) (wand, pulley) within pain
tolerance
2. Sub-maximal
isometrics for shoulder musculature
3. Manual
resistance for scapula motions
4. Postural
awareness education
5. Therapist
supervised UBE for motion, avoiding
substitution or impingement
6. Gentle soft
tissue mobilization
7. Modalities as
indicated for pain or inflammation
|
|
2-6 Weeks |
Progress PROM and AROM as tolerated
Joint mobilization for
scapula and glenohumeral (posterior capsular
stretching)
Strengthening
exercises for scapula stabilizers and
rotator cuff
May include PRE’s
theratube/band, PNF, UBE, and weight
equipment
Emphasis of
strengthening on high reps and low weight,
with postural awareness
Goal: Involved
shoulder AROM grossly within normal limits
by 6 weeks without shoulder hiking
|
|
6-12 Weeks |
Progress to
independent strengthening program.
Reinforce postural
awareness, quality of exercise techniques,
and proper progressive resistance exercise
(PRE) progression
|
MEDIUM
ROTATOR CUFF REPAIR PROTOCOL
Includes Treatment for:
Open Repair Medium Rotator Cuff
Tear
Arthroscopic Repair Small and Medium
Rotator Cuff Tear
|
Post Op |
Exercises |
|
0-2 Weeks |
Sling/swathe at all times, except for
exercises
PROM limits to: 90
pure abduction, 20 extension, 70 internal
rotation (also not behind back)
1. Pendulum
exercises 3x/day minimum
2. PROM within
limits and pain tolerance
3. Elbow and wrist
AROM 4x/day minimum
4. Cryocuff/ice:
days 1-2 as much as possible, then post
activity or for pain
|
|
2-6 Weeks |
Decrease use of
sling during the day, except in uncontrolled
situations and at night.
ROM limits continued.
1. PROM within limits
and pain tolerance
2. Manual
resistance for scapula motions
3. Postural
awareness education
4. Gentle soft
tissue mobilization and joint mobilization
5. Modalities as
indicated for pain or inflammation
|
|
6-12 Weeks |
Discontinue sling
at night.
No ROM
limits.
1. Progress
AAROM/AROM in all ranges, including wand and
pulleys
2. Joint
mobilization for scapula and glenohumeral
mobility
3. Gentle
strengthening exercises for scapula
stabilizers and rotator cuff.
May include sub-max
isometrics, theratube/band, PNF, and UBE.
Emphasis of
strengthening on high reps and low weight,
with postural awareness.
Goal: Involved
shoulder AROM grossly within normal limits
by 12 weeks
|
|
12-18 Weeks |
1. Resistive
exercises as tolerated
2. Progress
towards independent home program
Reinforce postural
awareness, quality of exercise technique,
and proper PRE progression
|
LARGE ROTATOR
CUFF REPAIR PROTOCOL
Includes
Treatment for:
Open Repair
Large Rotator Cuff Tear
Arthroscopic Repair Large Rotator Cuff Tear
|
Post Op |
Exercises |
|
0-2 Weeks |
Sling/swathe at all times, except for
exercises
PROM limits to:
90 pure abduction, 20 extension, 70 internal
rotation (not behind back)
1. Pendulum
exercises 3x/day minimum
2. PROM within
limits and pain tolerance
3. Elbow and
wrist AROM 4x/day minimum
4. Cryocuff/ice:
days 1-2 as much as possible, then post
activity or for pain
|
|
2-6 Weeks |
Sling/swathe at all
times, except for exercises, bathing or
sitting quietly
ROM limits
continued
1. PROM within
limits and pain tolerance
2. Manual
resistance for scapula motions
3. Postural
awareness education
4. Gentle soft
tissue mobilization and joint mobilization
5. Modalities as
indicated for pain or inflammation
|
|
6-12 Weeks |
Sling for comfort, but may be discontinued
No ROM limits
1. Initiate AAROM
(wand and pulleys), unless specified by
physician to progress more slowly
2. Joint
mobilization for scapula and glenohumeral
mobility
3. Gentle
exercises for scapula stabilizers and
rotator cuff
May include sub-max
isometrics, PNF, and supervised UBE
4. Progress AROM,
with education for quality of motion to
avoid shoulder hiking
*Patient must be
able to elevate without hiking shoulder to
progress
|
|
12-18 Weeks |
RESISTIVE
EXERCISES HELD AS PER SURGEON'S INSTRUCTION |
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