Arthroscopic Sub Acromial Decompression and/or A C J Excision

ASD/ACJ Excision

ASD and/or ACJ Excision

 

Indications:

  • Evidence of inflammation or scuffing on the under surface of the acromion, coracoacromial ligament & on the bursal side of the rotator cuff (i.e. presence of impingement

Procedure:

  • Removal of bone from the acromion & partial resection of the coracoacromial ligament
  • The AC joint remains intact unless excision is indicated, the distal clavicle and part of the acromion is removed
  • The superior AC ligament remains intact so that the joint remains stable

Protocol

 

Post op

Day 1

 

  • Mastersling (This should be removed within the first 2-3 days
  • Finger, wrist and elbow movements
  • Pendular exercises
  • Active (assisted) glenohumeral movement in all planes
  • Teach postural awareness and scapular setting
  • Book out patient appointment and ensure the patient has the advice booklet before discharge

1 Week

Out patient Physio


6 weeks

Levels 1-4 Exercises

  • Begin isometric strengthening (progress using pain & ROM as the limiting factor)
  • Over zealous physio or repetitive sustained overhead activity could lead to delayed healing & pain

 

  • Manual therapy if required to increase range of movement

 

 

Milestones

 

6 Weeks

Full active ROM or equivalent to the pre op range

Caution

Any significant increase in pain or decrease in ROM arrange a clinic appointment for a review

 
See Post-Operative Exercises

 Return to functional activities

Return to work            Sedentary job: as tolerated

                                    Manual job:      may need to modify activities for 3 months

 Driving                        1 week

Swimming                   Breaststroke:   as able

                                    Freestyle:          12 weeks

Golf                             6 weeks

Lifting                         as able

Racquet sports            Avoid repetitive overhead shots for 3 months

 

 

 

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