Arthroscopic Shoulder Stabilisation

Arthroscopic Shoulder Stabilisation

Post Op Protocol

The Operative Notes should accompany you on discharge in a folder with other documents including your physio referral. PLEASE give this information to the physio to individualise your rehab.

Also NOTE if a BICEPS TENODESIS was performed!!

Day 1 to day 7

– In hospital ICE / cryo-cuff every 2-3 hours

– Do not put up with pain!! Ensure you take adequate pain relief

– You may need to seeyour GP for additional medication or contact Dr Maguire’s Rooms

– If no contraindications use this pain relief regime

– PCA overnight then change to the following in am:

– Paracetamol 1gram four times a day

– Ibuprofen 400mg three times a day

– 10 to 20 mg of TARGIN (Oxycontin) twice a day

– 5-10 mg of Endone as required up to 3 hourly

– Ensure Fluid intake and bowel softening agents

– Prevent constipation from Endone/Targin

– Remain in sling unless doing physio or showering or if doing simple activity

– MUST wear sling to bed!!!

– Gentle pendulum exercises

(Forwards/Backwards)(Left/Right)

– Hand, wrist, elbow ROM (Range of Motion) as tolerated

– External rotation to neutral (0 Degrees only)

– Protect Biceps if Tenodesis performed

– Support Elbow

– No active contraction of biceps

– Scapula exercises (shrugs, protaction, retraction, rolls)

– As frequently as tolerated

– Maintain cardiovascular exercise after Day 3 may start walking, stationary bike

Weeks 2 to 6

– Continue exercises above

– Wean off Targin and Endone after first week. (Try to stop Targin after a few days and just take Endone when needed)

– Continue Panadol and Neurofen if no contraindications (Ask GP if not sure)

– Abduction sling on unless showering, eating or sitting

– Sling ALWAYS on for sleeping and when mobilising

– Remain in sling unless doing physio or showering or if doing simple activity

– MUST wear sling to bed!!!

– Gentle Pendular movements (Assisted)

– PROM (Passive Range of Motion) only!

– PROM Supine FE gently up to 140 (only 10 reps max)

– Table slides into FE as tolerated (only 10 reps max)

Figure 1. Table slide. (A) Starting position. While seated at a table, the patient places the hand of the affected shoulder on a sliding surface (e.g., a magazine that slides over a smooth table surface). (B) Ending position. The patient slides the hand forward, maintaining contact with the table, while the head and chest advance toward the table.

– External Rotation (ER) to 30 degrees (only 10 reps max)

– If large subscapularis tear ER to neutral till wk 6

– Internal rotation to buttock (only 10 reps max)

– Warm-up before exercises

– Walk for 1 minutes

– Warmth to shoulder (warm pack or warm shower)

– ICE after exercises for 30 mins

– Gentle isometric contractions of Rotator Cuff

– Start gentle theraband work if no rotator cuff repair

– Use core muscle exercises and lower limb exercises from Day 1 post Op

– e.g. Kibler Kinetic Chain Theory

– Protect Biceps if Tenodesis performed

– Support Elbow

– No active contraction of biceps

– Aerobic exercise (walking or stationary exercise bike)

Weeks 7 to 8

– Continue above exercises

– Discontinue sling after 6 wks and perform normal ADL’s (Activities of Daily Living)

– Begin Assisted AROM at 7wks (Unless Rotator Cuff Tear)

–  Assisted AROM includes “wall walking” for FE

– Push PROM to achieve FROM (Full Range of Motion)

– Start gentle theraband work 2 wks after Assisted AROM

        – Only for cuff muscles not repaired

        – e.g. Medium Tear at 10 wks

– Continue theraband work if no rotator cuff repair

– Continue cardiovascular conditioning

– Continue hand, wrist, elbow exercises

– Core strengthening especially transversus abdominis, multifidus

– Scapular mobilization / proprioception

– Avoid full abduction and external rotation as this may disrupt repair

Weeks 9 to 12

– Continue above exercises

– Begin Gym program

– May start running and pool work

– Progress from gentle breastroke to freestyle

– Avoid heavy lifting for 3 months

        – Lift with arms close to body

        – This avoids the “Lever Arm Effect”

– If significant stiffness or pain at 12 wks may consider corticosteroid injection

At 3 months

– Start capsular stretches

– Continue cuff strengthening

– Start formal gym program

– Advance cardiovascular conditioning

– Core strengthening

– Continue scapular mobilization / proprioception

– May consider return to contact sport or heavy manula labour at 4 months in shoulder brace

– Most patients return to sport at 6+ months

6 months to 12 months

– If stiffness persists for 12 months may consider arthroscopic capsular release