Arthroscopic Sub-Acromial Decompression (ASAD) +/- Acromio-Clavicular Joint (ACJ) Excision Rehabilitation Protocol.
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The guidelines are the same whether an Arthroscopic Sub-Acromial Decompression (ASAD) is performed in isolation or in conjunction with Acromio-Clavicular Joint (ACJ) excision.

Aims:
The aim of rehabilitation is to optimise function in the long-term.

General Points:
Do not push through pain.
Do not sacrifice quality of movement for range of movement.
Exercises should be pain free, but should challenge stamina.

Emphasis:
Regain range of movement of all affected joints.
Rehabilitate all aspects of rotator cuff function, control, strength and stamina.
Address general strengthening and core stability.
Postural re-education – at work and leisure.
Assess and treat other associated areas as necessary, such as the cervical and thoracic spine.

Immobilisation:
No formal period of immobilisation is required.
A sling is provided for comfort only.
Wean out of sling as soon as this is tolerated, preferably within 24 to 48 hours.

Post Operative Instructions:

From day 1:
Hand, Wrist and Elbow exercises.
Pendular exercises.

Active assisted exercises.
Encourage optimal Scapulo-Thoracic position.

There are no specific time scales, progression occurs as symptoms and Range Of Movement (ROM) allows.

Functional Milestones and Activity Time Scales:

Driving - See general principles of rehabilitation but typically at approximately 2 weeks.
Light work, sedentary - The patient may need 10 – 14 days but may return sooner if pain and function allow.
Heavy work or sustained over -head postures - Typically 6 weeks but a minimum of 3 weeks depending on symptoms.
Non contact sports - As comfort and ROM allows.
Contact sports – Typically 6-8 weeks as comfort and ROM allows.

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