Rehabilitation

Last updated November 2015

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Oswestry Sports Injury Surgery

Almost all the shoulder operations which I do can now be done through minimally invasive approaches (arthroscopic, “keyhole”). While this usually makes for a quicker recovery, it still takes the same biological period of time for tissues to heal. Shoulder reconstructions do tend to take longer than knees or ankles to become comfortable, but return to sport is usually at three months.

The commonest procedures which I do are debridements (including sub acromial decompression with or without excision of the acromio clavicular joint), stabilisations, and rotator cuff repairs. Essentially, if something has been repaired as opposed to trimmed or removed, then it needs a period of time to heal back (the glue set) before the repair is put under stress. This period of time is 3-6 weeks. During this period, we want the shoulder to move so that it doesn’t stiffen up too much, but under controlled circumstances, and often passively (that is, the joint being moved rather than moving using its own muscles)

Arthroscopic SubAcromial Decompression - ASAD (+/- excision of acromioclavicular joint - ACJ)

Weeks 0-3: Home morning after surgery in broad arm sling worn as required. Should be progressively weaned off over 2-3 weeks.
Removal of the suture if any at 10 days.
Pendulum / passive, unrestricted range of motion of the shoulder.
Finger & elbow movements.

Weeks 3-8: Near full range of motion now, institute active exercise emphasising posture, scapular setting, coordination & scapulohumeral cadence.
Driving, full activities of daily living, back to work at desk job.
Clinic appointment.

Weeks 8-12: Strengthening, but concentrating on quality of movements.

Weeks 12+: Unrestricted activities including sport. The shoulder should be back to 80% normal at this stage, but full recovery may take several more months.

Shoulder Stabilisation & SLAP repair

This is now very largely an arthroscopic procedure. The rehabilitation is very similar after open surgery, but tends to be somewhat slower.

Weeks 0-4: Home morning after surgery in broad arm sling with body belt worn 24/7 apart from for axillary hygiene.
Finger & elbow movements to prevent stiffness.
Removal of the suture if any at 10 days.
Movement to prevent stiffness, but avoid any outward rotation beyond neutral. This means keeping the thumb in line with the belly button or further across the body, never away from the side.
Isometric rotator cuff exercise in adduction & internal rotation.

Weeks 4-6: Unrestricted range of elevation now, but avoiding combined abduction from the side with external rotation.
Institute active exercise emphasising posture, coordination & scapulohumeral cadence.
Core stability, proprioceptive training.
Posterior capsular “sleeper stretches”.
Wean off sling completely by 6 weeks.
Driving, full activities of daily living, back to work at desk job.
Clinic appointment.

Weeks 6-8: Unrestricted range of movement. Unrestricted strengthening again concentrating on quality of movements, posture and especially scapulohumeral cadence.
Core stability proprioceptive training.
Open & Closed kinetic chain exercise.

Weeks 8-12: Resistance work, Plyometrics, medicine ball in position of vulnerability (with the arm away from the side.
Light throwing, tennis (no serving).

Weeks 12+: Unrestricted activities including sport. There is some evidence for the risk of recurrent instability is reduced by deferring the risk of re-injury to 6 months after surgery, especially in contact sports, but the risk is only slightly increased by return at 3 months, & most athletes are prepared to accept this.

Rotator Cuff Repair (Usually arthroscopic)

Weeks 0-4: Home morning after surgery in broad arm sling, occasionally splinted with a pillow to hold the arm away from the side.
Removal of the suture if any at 10 days.
Pendulum / passive limited range of motion.

Weeks 4-8: Gently pushing towards full range of motion now, by 8 weeks.
Institute active exercise emphasising posture, coordination & scapulohumeral cadence & setting.
No resisted exercise.
Driving, full activities of daily living, back to work at desk job.
Clinic appointment.

Weeks 8-12: Discontinue sling completely by now.
Resistance strengthening.

Weeks 12+: Progressive return to unrestricted activities including sport. This is variable and individualised depending on the exact findings at surgery.
If the tear was large and longstanding, it may well be at least six months before returning to sporting activities, & full recovery can take over one year.

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