Sub acromial Decompression (SAD)
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Sub acromial Decompression (SAD)

Phase I (post-op until week 2) Protective phase

  • Sling use for 0‐7 days as needed (or as directed by MD)
  • Elbow and hand ROM and hand squeezing exercises
  • Passive, AAROM, and AROM exercises as symptoms allow (starting with Passive.
  • Patient tolerance will determine progression)
  • Initiate shoulder isometrics and scapulothoracic re‐education and stabilization
  • Control inflammation and pain

Phase II (weeks 2-6) Intermediate phase

Weeks 2-4

  • Continue with ROM exercises (PROM/AAROM/AROM)
  • Use of pool therapy if possible for ROM and shoulder strengthening
  • Initiate gentle stretching exercises
  • Normalize shoulder and scapulothoracic arthrokinematics
  • Continue with isometric strengthening and begin with light total arm, rotator cuff and scapulothoracic stabilizer strengthening
  • Control pain and inflammation

**Progression based upon: AROM = forward flexion 90 degrees +, abduction 70 degrees+, ER in scapular plane 30 degrees, tolerance of current exercises and ADL’s, and patient compliance with home exercises and precautions

Weeks 4-6

  • Continue with ROM exercises with focus on increasing to full ROM
  • Progress with stretching exercises
  • Advance with shoulder rotator cuff, scapular stabilizers and total arm
  • strengthening(begin with no resistance and progression to weights and tubing), sidelying ER, and prone strengthening, and full can scaption
  • PNF with light manual resistance and rhythmic stabilization
  • UBE for strengthening and endurance training with proper scapulothoracic and shoulder positioning
  • Initiate joint mobilization (G/H, A/C, S/C, S/T) and posterior capsular stretching
  • Avoid compensatory patterns with strengthening (adjust as necessary with less reps or decreased resistance)

**Progression based upon: AROM = forward flexion 150 degrees +, abduction 140 degrees+, ER in scapular plane 40 degrees, tolerance of current exercises and ADL’s, and patient compliance with home exercises and precautions

Phase III (Weeks 6-10) Strengthening Phase

  • Full ROM (AAROM and AROM)
  • Continue with stretching
  • Continue to progress with strengthening ( scapular stabilizers, rotator cuff musculature, flexion and abduction movements, triceps and biceps)
  • Open and closed chain exercises and perturbation training
  • Rhythmic stabilization
  • Light initiation to sport activities as appropriate and patient tolerates

**Progression based upon full pain free ROM to functional demands, strength deficits less than 25%, good quality shoulder and scapulothoracic stabilization

Phase IV (Weeks 11+) Advanced Strengthening Initiation of Sport Activity

  • Continue with stretching exercises
  • Advanced strengthening (including overhead strengthening, isokinetic ER/IR strengthening at 90 degrees of abduction, increased isotonic training)
  • Endurance training
  • Rhythmic stabilization in all ranges and positions
  • Manual PNF resistance
  • Advanced closed kinetic chain exercises
  • Sport specific training

**Progression based upon pain free tolerance to training, strength deficits less than 10% throughout, completion of training program, and confidence in shoulder