Arthroscopic Sub-acromial Decompression (ASD) Rehabilitation Guidelines

Arthroscopic Sub-Acromial Decompression (ASD) Rehabilitation Guidelines

(+/- ACJ Excision / Longhead of Biceps Tenotomy)

These guidelines outline a structured physiotherapy programme for recovery after ASD surgery. The approach must be customised for each patient, ensuring exercises are pain-free and respecting post-operative restrictions. Emphasis is placed on allowing soft-tissue healing, restoring passive range of motion (PROM), achieving good scapulohumeral rhythm (SHR), and gradually progressing to strengthening.

Phases of Rehabilitation

Phase 1: 1–14 Days (Immediate Post-Surgery)

Goals:

1. Pain and Inflammation Management
   • Use analgesics, NSAIDs, ice, sling, and proper posture.
2. Teach Shoulder Control
   • Focus on scapular retraction and depression techniques.
3. Restore Initial ROM
   • Perform pendulum exercises with good SHR.
   • Begin ER/IR PROM, progressing to AAROM/AROM as tolerated.
4. Prevent Muscle Atrophy
   • Introduce sub-maximal isometrics (<30% MVC) in a pain-free range.
5. Support Healing
   • Maintain mobility in adjacent joints (hand, wrist, elbow, and neck).
6. Sleeping Position
   • Support the arm with pillows to avoid shoulder extension.

Precautions:

• Sling use: 3–7 days for comfort.
• Avoid forcing or stretching movements.
• Keep wounds clean and dry.

Milestones:

• Effective management of pain and inflammation.
• Return to pre-operative sleep patterns.
• Achieve good scapula setting.

Phase 2: 15 Days–6 Weeks

Goals:

1. Continue Pain and Inflammation Management
   • Incorporate manual therapy, taping, and alternative treatments as needed.
2. Restore ROM
   • Gradually regain full PROM and AROM as tolerated.
3. Improve Shoulder Stability
   • Focus on dynamic shoulder stability and good SHR during exercises.
4. Begin Proprioception Training
   • Introduce proprioceptive exercises, core strengthening, and light functional tasks.
5. Scar Management
   • Start scar massage after stitches are removed.

Precautions:

• Avoid excessive loading or repetitive overhead activities.

Milestones:

• Pain and inflammation are minimal.
• Achieve good SHR with AROM.

Phase 3: 7–14 Weeks

Goals:

1. Achieve Full ROM
   • Add multi-directional stretching and capsular stretches as needed.
2. Strengthening and Stability
   • Progress scapular stabilisation and rotator cuff strengthening.
   • Move from isometrics to isotonic strengthening as tolerated.
3. Dynamic and Functional Training
   • Gradually introduce dynamic stabilisation and functional activities.
4. Proprioceptive and Core Strengthening
   • Continue advancing proprioception and kinetic chain exercises.

Precautions:

• Avoid heavy, repetitive, or prolonged overhead tasks.

Milestones:

• Resolved pain and inflammation.
• Achieve AROM with good SHR through full elevation.

Phase 4: 3–9 Months

Goals:

1. Maintain ROM and Stability
   • Continue PROM and AROM exercises with good SHR.
2. Advance Strengthening
   • Focus on cuff strengthening, scapular stabilisation, and dynamic stabilisation.
3. Progress Functional and Sport-Specific Training
   • Gradually increase intensity and complexity of exercises.

Milestones:

• Full, pain-free motion with good SHR at 4 months.

Contact Information

• Consultant Secretary: 07810 356433
• Sulis Hospital Physiotherapy: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

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