Subacromial Decompression +/- ACJ Excision

Indications

Evidence of inflammation or scuffing on the under surface of the acromion, coracoacromial ligament and  on the bursal side of the rotator cuff (i.e. presence of impingement)

Procedure

  • Removal of bone from the acromion & partial resection of the coracoacromial ligament.
  • The AC joint remains intact unless excision is required due to pain localising to this site when the distal clavicle and part of the acromion is removed.
  • The superior AC ligament remains intact so that the joint remains stable.

Protocol:

Post Operation:

On Discharge from Hospital 

  • Immobiliser (This should be removed within the first 2-3 days)
  • Post-op Exercises on discharge 
  • Active (assisted) glenohumeral movement in all planes
  • Teach postural awareness and scapular setting

Out patient Physio

  • Begin isometric strengthening (progress using pain & ROM as the limiting factor)
  • Rotator cuff strengthening
  • Address posterior capsular tightness (sleeper stretch and cross-shest adduction)
  • Over zealous physio or repetitive sustained overhead activity could lead to delayed healing & pain
  • Manual therapy if required to increase range of movement

Milestones

  • Full recovery can take 6-9 months.
  • Expect 80% improvement by 3 months.

6 Weeks

  • Full active ROM or equivalent to the pre op range

Caution: Any significant increase in pain or decrease in ROM arrange a clinic appointment for a review.

Return to functional activities

Return to work           

  • Sedentary job: as tolerated       
  • Manual job:      may need to modify activities for 3 months

Driving                      

  • 4 weeks

Swimming                  

  • Breaststroke:  as able                                 
  • Freestyle:       12 weeks

Golf                            

  • 6 weeks

Lifting                        

  • as able

Racquet sports           

  • Avoid repetitive overhead shots for 3 months

Contact Sport  (e.g. Rugby, Rugby League, AFL football, martial arts, racket sports and Surfing)

  • 3 months

 

 

 

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