Subacromial decompression yields a better clinical outcome than therapy alone. No lifting of anything over 1 to 2 pounds for 8 weeks. Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any orthopaedic surgeons armamentarium. This is keyhole surgery, usually performed under a combination. Effectiveness of standardized physical therapy exercises for. The subacromial decompression procedure involves removing tissue from the front part of the shoulder. Arthroscopic subacromial decompression physical therapy protocol phase i.
Subacromial impingement syndrome sais is the commonest disorder of the shoulder, accounting for 4465% of all complaints of shoulder pain. Subacromial decompression surgery regenexx jacksonville. Click here to watch subacromial decompression rehabilitation exercises and follow step by step instructions provided by dr peter in claremont, murdoch. Main outcome measures pain, physical function and healthrelated quality of life. Subacromial decompression, beverly ma acromioplasty. Immediate motion weeks 0 to 2 goals reestablish nonpainful range of motion prevent muscular atrophy reestablish dynamic stability decrease pain and inflammation week 1 exercise elbowwristhand exercises pendulums. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The arthroscope is introduced through the skin and deltoid muscle to enter the shoulder joint. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Frank, md team physician, university of colorado athletics assistant professor, department of orthopaedic surgery university of colorado school of medicine. One randomised controlled trial compared decompression plus subacromial bursectomy with bursectomy alone and. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Various table manufacturers provide some form of training with their devices.
Passive, aarom, and arom exercises as symptoms allow starting with passive. Arthroscopic slap repair arthroscopic subacromial decompression deltoid reeducation dynamic stability for. Arthroscopic subacromial decompression for subacromial shoulder. Bone spur removed and coracoacromial ligament ca ligament cut. Shoulder decompression surgery is no more effective than. The operation aims to increase the size of the subacromial area and reduce the pressure on the muscle. It is no means intended to be a substitute for ones clinical decision making regarding the progression of a. The acromion is a large bony projection on the outer part of the shoulder blade scapula that forms part of the shoulder joint. As technology has advanced the techniques have been altered, adapted and improved, with the intention of optimising patient outcome.
Arthroscopic subacromial decompression surgical technique. Sub acromial decompression surgery postoperative rehabilitation programme about the operation if your shoulder has not recovered with appropriate conservative management, the next step to consider is surgery, with the treatment of choice being an arthroscopic subacromial decompression. Subacromial decompression and acromioplasty jeffrey h. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. This is a guideline for your physiotherapist to help you progress your shoulder rehabilitation. Subacromial decompression surgery is a very common procedure performed for people with shoulder pain. This protocol provides you with general guidelines for the rehabilitation of a patient following an arthoscopic subacromial decompression sad. Arthroscopic shoulder decompression cleveland clinic. Panek, md 68 visits over 34 months emphasis is on aarom and a high repetition, low weight free weight program address posterior capsular tightness if indicated address scapular malpositioning if indicated minimal to no pain during or after exercises, although fatigue is ok no passive rom prom or pulleys unless specifically indicated by. Arthroscopic subacromial decompression boston shoulder institute. Arthroscopic subacromial decompression shoulderdoc by.
October 7, 20 subacromial decompression posterior and. Subacromial decompression surgery was introduced in 1972 as a treatment for this type of shoulder impingement. Finnish subacromial impingement arthroscopy controlled trial ncbi. Should you get subacromial decompression to treat shoulder. Subacromial decompression versus diagnostic arthroscopy. Does subacromial decompression surgery really do anything. Mclaughlin performing an acromioplasty and rotator cuff repair. Arthroscopic subacromial decompression protocol biceps tenodesis precautions. This procedure is indicated for refractory subacromial bursitis and subacromial impingement. You will be placed in a sling to be worn at all times following surgery.
Three tiny incisions are made in the shoulder area. This part of the shoulder is referred to as the subacromial space, as it is located below the outcropping of bone on the scapula shoulder blade know as the acromian process. Subacromial impingement syndrome accounts for a large proportion of patients with shoulder pain. A prospective randomized study of patients with a minimum 10year followup stefanos farfaras, md, msc, ninni sernert, rpt, phd, lars rostgard christensen, md, erling k. Subacromial decompression protocol starts with a few small cuts made in the shoulder area. The surgery also carries significant risks, including major bleeding, deep infections.
The first postoperative appointment will be 1014 days following the procedure. We hypothesized that standardized physical therapy exercises would yield. Subacromial impingement results from repetitive trauma to structures 20 underneath the subacromial arch leading to a decrease in the subacromial space, 21 impingement of soft tissue, and ultimately a decrease in functional abilities. Data sources systematic searches for benefits and harms were conducted to 23 july 2018 in. Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. It involves cutting the ligament and shaving away the bone spur on the acromion bone. Progressing to supine arom as tolerated painfree and gentle posterior ir4 weeks initiate ckc exercises o horizontal table or counter wash o vertical wall wash o diagonal patterns done last when tolerable o 4 pt. Loose bodies may be found and an overall assessment. These inflammatory or degenerative changes often leave the shoulder feeling achy and sore during everyday activities. Subacromial decompression surgery is a common procedure. Restrictions rom 140 degrees of forward flexion 40 degrees of external rotation 60 degrees of abduction rom exercises begin with the arm comfortably at the patients side, progress to. A subacromial decompression is a surgery performed to create more space above the rotator cuff to allow for unrestricted movement of the rotator cuff under the acromion. Arthroscopic subacromial decompression protocol sports and. Subacromial decompression surgery for adults with shoulder.
Shoulder impingement and subacromial decompression desio. Subacromial decompression postoperative time line 1. Arthroscopic subacromial decompression physical therapy. Treatment options for sais can be classified into conservative or surgical. The protocol is divided into phases, which are adaptable based on the individual and special circumstances. But recent research has challenged the effectiveness of the procedure, and even the diagnosis of subacromial. Subacromial decompression rehab shoulder exercises perth. Elbowwristhand rom, pendulums, wall stretch at home per instruction sheets. Sad subacromial decompression protocol phase i postop until week 2 protective phase. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a subacromial decompression. Subacromial decompression protocol south shore orthopedics. Acromioplastysubacromial decompression postoperative. Pdf physical therapy management of a patient after a. Subacromial decompression yields a better clinical outcome.
The arthroscope and specialized surgical tools are inserted into the incisions and the surgeon uses a video monitor to view the damaged area and excise the bone spurs and bursitis, as needed. Subacromial decompression, also known as an acromioplasty, is a surgical procedure to alleviate shoulder pain and impingement. Arthroscopic subacromial decompression and acromioplasty. After arthroscopic subacromial decompression intact. The patient is initially given anesthesia, either general anesthesia or regional anesthesia based. Doctors follow the following steps when conducting subacromial decompression surgery. It is also a routine portion of rotator cuff repair. The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Objective to assess the efficacy of arthroscopic subacromial decompression asd by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a nonoperative alternative, exercise therapy, in a more pragmatic setting. Contact us for more information or to book an appointment please fill out this form, email us, or give us a call. You will be given a prescription for physical therapy that will start 34 weeks after. Objective to determine the benefits and harms of subacromial decompression surgery in adult patients with subacromial pain syndrome lasting for more than 3 months. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a.
Cole,md,mba range of motion sling exercises phase i 04 weeks prom as tolerated 02 weeks. Dcompression therapy has been firmly established in the health care arena for some time now. After completing the subacromial decompression postop recovery phase, i am sharing 10 tips for a successful recovery. Once in the joint, a methodical inspection of the tissues is performed looking for tears in ligaments, muscles and tendons. Does arthroscopic subacromial decompression really work. Setting orthopaedic departments at three public hospitals in. The procedure is often recommended for people with shoulder impingement and was originally theorized to open up the subacromial space and help reduce biomechanical impingement. The physician will make specific changes to the program as appropriate for an individual patient. Subacromial decompression surgery is performed as an outpatient procedure, where in the patient can be discharged in the same day of surgery. I diligently followed the doctor and physical therapists protocols.
If thorough nonoperative treatment fails, subacromial decompression sad with partial acromioplasty may help reduce mechanical impingement and optimize shoulder function in. Arthroscopic subacromial decompression requires at least two 5mm incisions. At the time, this procedure was developed without highlevel evidence, but nonetheless, it is now the most common arthroscopic surgical procedure performed at the shoulder glenohumeral joint. Arthroscopic subacromial decompression for subacromial. Subacrominal impingement is a condition where the rotator cuff tendon is pinched between the humeral head and the under surface of the acromion. Subacromial decompression surgery is no longer advised. The arthroscope sends pictures that guide the surgeon. Arthroscopic video of a subacromial decompression with an acromioplasty for subacromial impingement syndrome. Design multicentre, three group, randomised, double blind, sham controlled trial. Postoperative protocol arthroscopic decompression is normally the result of the clinical diagnosis of shoulder impingement syndrome. Orthopaedic therapy protocols macclesfield shoulder, elbow. Post operative arthroscopic subacromial decompression. After arthroscopic subacromial decompression intact rotator cuff distal clavicle resection rehabilitation protocol. Develop and maintain full pain free range of motion rom of the shoulder.
Post operative arthroscopic subacromial decompression protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone an arthroscopic subacromial decompression. A clinical practice guideline in bmj recommends that subacromial decompression surgery, also known as shoulder impingement surgery, should no longer be offered to patients, because it has little or no effect on pain, function, or quality of life. Subacromial decompression is a relatively noninvasive arthroscopic procedure to treat subacromial impingement syndrome. Avoid a subacromial decompression surgery based on this data and focus on strengthening the shoulder and creating more stability. Physical therapy prescription arthroscopic subacromial. It results from an inflammation and degeneration of the anatomical structures in the region of the subacromial space. The number of patients undergoing subacromial decompression in england uk rose by seven times from 2523 in 2000 to 21 355 in 2010. Unblinded trials at high risk of bias have failed to demonstrate the benefit of subacromial decompression surgery compared with exercise therapy for subacromial pain syndrome. Your physician may recommend arthroscopic subacromial decompression if. There are multiple options for this including physical therapy, restoring the normal alignment of the shoulder and cervical spine, and potentially treating the ligaments andor tendons of the shoulder with your own. A subacromial decompression acromioplasty can be performed through an all arthroscopic technique. Arthroscopic subacromial decompression is a common surgical procedure and has been well described over the last thirty years. The intent of posting these standards of care and protocols is to provide clinicians and patients. Next, the surgeon inserts the tubelike arthroscope.
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