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 toleratedGoals:  140° of Forward Flexion, 40° of External Rotation at side, Internal Rotation behind back with gentle posterior capsular stretchingNo abduction-external or internal rotation (90/90) until 4-8 weeks post-op
3. Goals:  140° of Forward Flexion, 40° of External Rotation at side, Internal Rotation behind back with gentle posterior capsular stretching
4. No abduction-external or internal rotation (90/90) until 4-8 weeks post-op
5. Therapeutic ExerciseCodman’s/Pulleys/CaneElbow/Wrist/Hand Range of MotionGrip StrengtheningNo resistive exercises
6. Codman’s/Pulleys/Cane
7. Elbow/Wrist/Hand Range of Motion
8. Grip Strengthening
9. No resistive exercises
10. 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 toleratedGoals: 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. 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
3. Therapeutic ExerciseBegin light isometrics with arm at the side for rotator cuff and deltoidAdvance to therabands as toleratedPassive stretching at end range of motion to maintain shoulder flexibility
4. Begin light isometrics with arm at the side for rotator cuff and deltoid
5. Advance to therabands as tolerated
6. Passive stretching at end range of motion to maintain shoulder flexibility
7. 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 toleratedIsometrics -> therabands -> weightsBegin eccentrically resisted motions, closed chain exercises and plyometrics8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
3. Isometrics -> therabands -> weights
4. Begin eccentrically resisted motions, closed chain exercises and plyometrics
5. 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
6. Modalities per PT discretion