Presentation Transcript

  1. SUB-ACROMIAL DECOMPRESSION (SAD) ACROMIOPLASTY/ACROMIONECTOMY Dr. Bienz This procedure is performed to relieve the pain associated with impingement syndrome The following protocol is for an open procedure where the anterior deltoid muscle is divided to gain access to the acromioclavicular joint, subacromial space and rotator cuff for inspection. The patient is placed in a sling or an ultra sling to discourage active use until three to four weeks. AROM of the glenohumeral joint is not permitted until after 5 weeks following the surgery due to repair of the anterior deltoid muscle. IMMEDIATE POSTOPERATIVE PHASE, DOS: ●Released from surgery in a sling or an ultra-sling, to be worn between exercise sessions and at night ●Active elbow, wrist and hand exercises ●Pendulum exercises within pain restraints ●Scapular retraction, protraction, depression and elevation are encouraged. ●Active external and internal rotations are permitted as long as the arm is kept in neutral position at the patient’s side. No active forward flexion. ●TENS, modalities and ice can be used if necessary for pain control ONE-TWO WEEKS POSTOPERATIVE, Begin Date: ●Continue postoperative phase instructions ●Begin passive range of motion in all planes except extension (extension stresses the repaired deltoid). Attempt to achieve full passive range of motion by postoperatively week four. WEEK TWO, Begin Date: ●Continue postoperative instructions ●Continue PROM ●Table slides for self passive range of motion could be beneficial for forward flexion and abduction/scaption ●May begin light resisted exercises for wrist and hand

  2. WEEK THREE, Begin Date: ●Continue previous instructions ●Scar massage with lotion is initiated WEEK FOUR, Begin Date: ●Pulley exercises may be initiated WEEK FIVE POSTOP, Begin Date: ●Discontinue sling or ultra-sling...per physician instruction ●May initiate active range of motion-forward elevation ●May begin active extension ●If chronic stiffness persists heat and joint mobilization can be added WEEK EIGHT POSTOP, Begin Date: ●Progressive strengthening program is initiated. Emphasis will be on scapular stabilizers initially with theraband. Progress with weights as comfort permits. ●Avoid impingement positions and activities 3-6 MONTHS POST OP, Begin Date: ●Continue strengthening 2-3 times per week ●Return to normal activities, including sports as tolerated/per physician orders SAD – Bienz 1-04