Arthroscopic Subacromial Decompression & Distal Clavicle Resection Protocol

Rehabilitation after Arthroscopic Subacromial Decompression and Distal Clavicle Resection focuses on controlling early pain, protecting the healing joint, and systematically rebuilding shoulder mobility and strength. Because no tendons are repaired during this procedure, motion can progress more quickly than after a rotator cuff repair. However, protecting the resected distal clavicle (the collarbone joint) is vital during the early weeks of recovery.

Phase 1: Protective & Passive Motion Phase (Weeks 0 to 3)

Goals:

• Protect the healing subacromial space and the resected collarbone joint.
• Control post-operative pain, inflammation, and joint swelling.
• Restore passive and active-assisted range of motion.
• Prevent compensatory muscle guarding around the neck and shoulder blade.

Precautions & Restrictions:

• Wear the sling for the first 7 to 10 days for comfort, removing it for exercises and light daily activities as tolerated. Discontinue sling by the end of Week 2.
• Critical Precaution: Avoid cross-body (horizontal) adduction and end-range internal rotation stretches for 6 to 8 weeks to protect the collarbone joint from compressive stress.
• Do not lift or carry objects heavier than a cup of coffee with the surgical arm.
• Avoid active arm elevation against gravity if it causes sharp pain.

Suggested Exercises:

• Pendulum (Codman’s) exercises for gentle joint distraction and relaxation.
• Active range of motion exercises for the elbow, wrist, and hand.
• Passive and active-assisted range of motion in flexion and abduction within pain-free limits.
• Scapular stabilization exercises, including shoulder shrugs, retractions, and depressions.

Criteria to Progress:

• Surgical pain is well controlled at rest.
• Near-full passive flexion and external rotation achieved within tolerable pain levels.
• Ability to perform active movement of the elbow, wrist, and hand without pain.

Phase 2: Active Range of Motion & Early Strengthening Phase (Weeks 3 to 6)

Goals:

• Restore full active range of motion in all planes of movement.
• Normalize scapulohumeral rhythm to ensure correct shoulder movement patterns.
• Initiate gentle submaximal isometric strengthening.
• Gently stretch the posterior capsule without compressing the collarbone joint.

Precautions & Restrictions:

• Continue to avoid cross-body stretches and extreme end-range movements.
• Do not lift objects heavier than 5 pounds with the surgical arm.
• Avoid sudden, jerking movements; all exercises must be performed smoothly.
• Discontinue any exercise that causes sharp, localized pain at the collarbone joint.

Suggested Exercises:

• Active-assisted to active range of motion in flexion, scaption, and external rotation.
• Submaximal, pain-free isometric exercises for the rotator cuff and deltoid.
• Periscapular strengthening, including row progressions, scapular clocks, and serratus punches.
• Early light resistance band exercises for internal and external rotation below 90 degrees of elevation.

Criteria to Progress:

• Full active range of motion in flexion and abduction without shoulder shrugging.
• No pain during light activities of daily living.
• Rotator cuff and periscapular strength showing progressive improvement with light resistance.

Phase 3: Progressive Strengthening & Functional Return Phase (Weeks 6 to 12+)

Goals:

• Restore full strength, power, and muscular endurance.
• Re-establish dynamic shoulder stability during movement.
• Gradually return to full, unrestricted work, sports, and recreational activities.

Precautions & Restrictions:

• Gradually introduce horizontal adduction and overhead lifting, ensuring no sharp pain at the collarbone joint.
• Avoid rapid, high-impact weight progression; build load gradually.
• Warm up thoroughly before any heavy lifting or sport-specific training.

Suggested Exercises:

• Progressive resistance exercises using bands and dumbbells for the rotator cuff and periscapular muscles.
• Advanced periscapular strengthening, including prone horizontal abduction, T/Y/W exercises, and incline push-ups.
• Dynamic stabilization drills, such as ball stabilization and proprioceptive exercises.
• Sport-specific or work-specific simulation exercises starting around Week 8 to 10.

Criteria to Progress:

• Pain-free active range of motion in all planes, including overhead and cross-body movements.
• Rotator cuff and periscapular strength is at least 85-90% compared to the uninjured side.
• Successful completion of sport-specific or work-specific simulation drills without post-exercise pain or swelling.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.