Subacromial decompression and ACJ excision
Arthroscopic Subacromial Decompression + Arthroscopic Excision of Distal Clavicle (ACJ resection)
Wear sling as needed for rest and pain relief for approx. 2 days.
Avoid axial loading through upper limb.
Exercises and advice sheet given by physio i.e. active assisted exercises, GHJ – elevation and lateral rotation, posture, scapula setting and isometric cuff. No limitations in range of movement BUT active exercises dependant on pain limitation and muscle control of movement. – do not encourage full range into pain. Most patients remain below 90 degrees AROM in first 2-3 weeks.
Care of sling and washing techniques.
Removal of sling for gentle exercises advised 4 times/day.
May be limited by pain but can progress > 90° elevation after the first 2/52. No restrictions in ROM, dependant on active muscle control and pain.
Progress as subacromial decompression. Patients may be have more pain at end range elevation than standard ASAD so progress may be slower with longer rehabilitation time.
6 weeks +
Functional and sports specific rotator cuff and scapular training through range, to include proprioception.
Return to work: Sedentary 2-3 weeks (as pain allows). Physical 4-6 weeks (as pain allows).
Driving: 2 weeks (as pain and range allows) patient confirms they are able to drive safely.
Sport: Non contact 2-3 months. Contact 3-6months
Swimming: Gentle with modified stroke 3-4 weeks. Freestyle 8 weeks