Arthroscopic Subacromial Decompression/Distal Clavicle Excision

Phase I (Weeks 0-4)

1. Sling immobilization for comfort Weeks 0-2 – Discontinue sling use at 2 weeks
2. Range of Motion – PROM → AAROM → AROM as tolerated
   • Goals: 140° of Forward Flexion, 40° of External Rotation at side, Internal Rotation behind back with gentle posterior capsular stretching
   • No abduction-external or internal rotation (90/90) until 4-8 weeks post-op
3. Therapeutic Exercise
   • Codman’s / Pulleys / Cane
   • Elbow/Wrist/Hand Range of Motion
   • Grip Strengthening
   • No resistive exercises
4. Heat/Ice before and after PT sessions

Phase II (Weeks 4-8)

1. Range of Motion – Increase Forward Flexion, Internal/External Rotation to full motion as tolerated
   • Goals: 160° of Forward Flexion, 60° of External Rotation at side, Internal Rotation behind back and at 90° of abduction with gentle posterior capsular stretching
2. Therapeutic Exercise
   • Begin light isometrics with arm at the side for rotator cuff and deltoid
   • Advance to therabands as tolerated
   • Passive stretching at end range of motion to maintain shoulder flexibility
3. Modalities per PT discretion

Phase III (Weeks 8-12)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic Exercise
   • Advance strengthening as tolerated
   • Isometrics → therabands → weights
   • Begin eccentrically resisted motions, closed chain exercises and plyometrics
   • 8–12 repetitions / 2–3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
3. Modalities per PT discretion