Post-Operative Instructions – Subacromial Decompression, ACJ Excision, Capsular Release, LHB Tenotomy

This information is general and may vary from case to case. It applies equally to an isolated subacromial decompression and also if an ACJ excision and / or LHB tenotomy has been performed. It also applies after capsular release for frozen shoulder.

Dr Smith's rehab protocols are currently being reviewed and updated. Please contact the rooms for the latest version.

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General points

  • Improvement can continue for 18-24 months post-operatively
  • Initial progress is variable – it can be rapid or seem slow
  • Do not push through pain. But exercises should challenge your stamina.
  • A sling is provided for comfort only.
  • Wean out of sling as soon as this is tolerated, preferably within 24 to 48 hours.
  • Take some painkillers about 30 mins before you do your exercises
  • Use ice afterwards for the first 2 weeks

These exercises are gentle and aim to maintain range of motion in the early painful phase of recovery (first 2 weeks). There are no restrictions on your activity other than what pain dictates so if these exercises are too easy for you you then try to do more.

Scapular positioning (shoulder blade)

The shoulder blade provides a solid foundation for your shoulder. Typically the shoulder will slouch forward in a sling – this is not a good position so work on scapular positioning is vital.
  • Squeeze your shoulder blades downwards and together. Hold for 5 seconds. Repeat 5 times
  • Shrug your shoulders then roll them backwards and downwards. Hold for 5 seconds

How often
  • 4 times per day
  • If you can do more – go for it

Neck stretches

Your neck will get sore and stiff particularly while wearing the sling
  1. Move ear towards shoulder. Hold for 10 seconds. Repeat for other side
  2. Try to look over your shoulder. Hold for 10 seconds. Repeat for other side

How often
  • 4 times per day
  • If you can do more – go for it

Hand, wrist, forearm and elbow exercises

These joints will stiffen up rapidly if not moved while in the sling.

  • Hand & Wrist
    Keep your arm in the sling and move your hand up and down at the wrist. Clench and unclench your fist
  • Forearm
    With your arm in the sling and the elbow bent at your side, turn the hand to face the ceiling and then the ground.
  • Elbow
    With your arm out of the sling bend and straighten the elbow.

How much
  • 10 of each exercise 4 times per day
  • If you can do more – go for it

Pendular exercises

  • Bend forward at your waist. Let your (operated) arm relax and hang down with your palm facing inwards
  • Circle your arm clockwise making the circle bigger and bigger
  • Circle your arm anticlockwise making the circle bigger and bigger
  • Perform 10 circles in each direction

How often
  • 4x per day

Self passive / Active assisted forward elevation as pain allows

  • Lie on your back. Lock the fingers of each hand together.
  • Lift your arms up towards and then above your head. Straighten your elbows.
  • As pain improves this exercise can be performed in the sitting position. Hold for 10 seconds. 5 repetitions.
  • Then clasp your hand behind your head and allow your elbows to fall out to the sides. Hold for 10 seconds. 5 repetitions.

How many
  • Repeat 4 x per day.

Self passive / Active assisted external rotation

  • Sit with operated arm resting on a pillow palm facing inwards
  • Steady it with your other hand
  • Rotate your hand outwards as far as pain allows. You can push it a bit further with your good hand
  • Hold for 10 seconds.

How often
  • 4 times per day

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Sydney Orthopaedic Trauma and Reconstructive Surgery
Suite 5, Level 2
19 Kensington Street
Kogarah NSW 2217