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Subacromial Decompression

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Rehabilitation after isolated arthroscopic subacromial decompression — early movement, staged strengthening and return to activity.

Updated Jun 2026
Illustrasyon ng isang tao na nakahiga sa likod, itinataas ang isang patpat patungo sa kisame gamit ang magkawang na kamay.
Tumulong sa paggalaw ng kamay sa itaas sa mga unang linggo pagkatapos ng subacromial decompression. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay sumasaklaw sa rehabilitasyon pagkatapos ng iisang arthroscopic subacromial decompression (acromioplasty, may o walang pag-alis ng pamamaga ng bursa) kay Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa pisyoterapeuta upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong rehabilitasyon ay unti-unting pinapahusay ng iyong pisyoterapeuta sa pamamagitan ng mga yugto sa ibaba, depende sa pag-unlad ng iyong balikat.

Mahalaga: Ang subacromial decompression ay madalas na isinasagay kasama ng rotator cuff repair. Ang protocol na ito ay para sa iisang subacromial decompression. Kung ang iyong operasyon ay kasama rin ng rotator cuff repair, sundin ang rotator cuff repair protocol; mas mabagal ang takbo ng repaired tendon.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Madalas na nakakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang subacromial decompression ay nagbibigay ng mas maraming espasyo para sa mga tendon ng rotator cuff sa pamamagitan ng pag-aalis ng bahagi ng ilalambot ng acromion (ang butong bubong ng balikat) at pag-alis ng inflamed na bursa. Walang ginagamot na kailangang protektahan, kaya ang maagang rehabilitasyon ay tungkol sa paggalaw, hindi sa pahinga: ligtas ang balikat na galawin mula sa unang araw, at ang maagang paggalaw ang nagpapatibay nito upang hindi ito mahigpit habang nagpapahinga.

Ang sling na matutulog mo ay para sa kaginhawaan lamang; hindi ito nagpoprotekta sa anumang bagay. Iwan itong hindi suot nang kung maaari at unti-unting huwag na itong suotin nang maaga: karamihan sa mga tao ay hindi na sumusulat ng sling sa loob ng unang ilang araw, at ang mga publikadong protokol ay inaasahang ito ay alisin na sa loob ng dalawang linggo ang pinakahuli. Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng anumang operasyon sa balikat, kahit na alreadi na alisin ang sling; ang iyong surgeon ang magbibigay ng pahintulot na magmaneho, karaniwan sa pagsusuri sa anim na linggo.

Ang iyong programa ng ehersisyo ay gumagamit ng tatlong uri ng paggalaw, at ang iyong physiotherapist ang gabay kung alin ang angkop sa bawat yugto:

  • Aktibong saklaw ng paggalaw: ang paggalaw ay pinapayagan nang walang tulong o tulong.
  • Aktibo-panulong saklaw ng paggalaw: paggamit ng ibang braso o bagay upang tumulong sa paggalaw ng braso.
  • Pasibong saklaw ng paggalaw: ganap na nakarelaks, gamit ang ibang braso o lakas upang gawin ang 100% ng trabaho.

Ang paglalakbay sa isang tingin:

  • Yugto I — Maagang paggalaw — humigit-kumulang ang unang dalawang linggo
  • Yugto II — Pagbawi ng iyong saklaw at pagsisimula ng lakas — linggo 2–6
  • Yugto III — Pagpapalakas — linggo 6–12
  • Yugto IV — Pagbabalik sa buong aktibidad — linggo 12 pataas

Karaniwang mas masakit kaysa mahina ang balikat sa mga unang linggo, at may ilang tao ang nakakaramdam na ito ay nananatiling hindi komportable hanggang anim na linggo. Ang mga publikadong gabay ay nagmumungkahi na karamihan sa mga tao ay nakakaramdam ng malinaw na pagpapabuti sa sakit sa loob ng humigit-kumulang tatlong buwan, at ang mga sintomas ay maaaring patuloy na umuunlad hanggang isang taon. Ang mga saklaw ng linggo sa ibaba ay karaniwan imbes na nakatakda; ang iyong physiotherapist ang magpapatuloy sa iyo base sa kung paano gumagalaw ang iyong balikat, hindi sa kalendaryo.

Phase I — Maagang paggalaw (Linggo 0–2)

Kadalasan ay gumagamit ng nerve block habang isinasagawa ang operasyon, kaya maaaring manatiling manhid ang braso sa loob ng ilang oras pagkatapos nito; simulan ang iyong mga painkiller bago ito mawala. Sa unang dalawang linggo, simple lamang ang mga layunin: pakalmahin ang sakit at pamamaga, at pagalawin ang balikat sa abot ng iyong komportable. Gumamit ng ice nang regular para sa pagpapaginhawa ng sakit. Simulan agad ang paggalaw ng iyong kamay, pulso, at siko, magdagdag ng mga pendulum exercise at assisted arm movements hangga't kaya ng iyong komportable, at gamitin ang braso para sa mga normal at magagaan na pang-araw-araw na aktibidad tulad ng paghuhugas, pagbibihis, at pagkain. Inumin ang iyong mga painkiller bago ang iyong mga exercise at bago ang mga appointment sa physiotherapy. Ito ay keyhole surgery, karaniwang sa pamamagitan ng dalawa o tatlong maliliit na puncture wound na natatakpan ng mga waterproof dressing; maaari kang maligo nang nadadapsanan ang mga ito simula sa unang araw (huwag ibabad o kuskusin), at mananatili ang mga ito hanggang sa iyong wound review sa ika-10–14 na araw. Ang mga taong may desk-based jobs ay karaniwang bumabalik sa trabaho sa loob ng unang dalawang linggo; ang pagmamaneho ay maghihintay hanggang sa payagan ka ng iyong surgeon, karaniwan sa six-week review.

Para sa iyong physiotherapist:

Mga Layunin

  • Pakalmahin ang sakit at pamamaga
  • Ibalik ang range of motion na walang sakit (active-assisted patungo sa active)
  • Pigilan ang muscular atrophy at simulan ang pagbabalik ng dynamic stability
  • Pagiging independent sa mga magagaan na activities of daily living

Pamamahala

  • Cryotherapy nang regular para sa sakit at pamamaga; analgesia bago ang mga exercise at session
  • Elbow, wrist, hand, neck, at thoracic range-of-motion exercises simula sa unang araw
  • Pendulums; pulley o wand active-assisted elevation sa scapular plane; external at internal rotation simula sa 30–45° ng abduction
  • Mag-progress sa active range of motion hangga't kaya ng iyong komportable
  • Scapular setting habang nakaupo; postural awareness
  • Submaximal isometrics (flexion, extension, abduction, external at internal rotation) at gentle rhythmic stabilisation
  • Simula sa ika-2 linggo: init bago ang exercise kung nakatutulong; i-progress ang rotation work patungo sa 90° ng abduction; external at internal rotation gamit ang elastic tubing, ang braso ay nasa gilid

Mga Pag-iingat

  • Magtrabaho sa loob ng mga comfortable range: huwag pilitin o i-overstretch; ang sakit ang magsisilbing gabay
  • Sling para sa komportable lamang; unti-unting bawasan ang paggamit sa unang mga araw at alisin na pagdating ng ikalawang linggo
  • Bawal magmaneho sa loob ng anim na linggo (nalalapat ito sa anumang operasyon sa balikat)
  • Bawal ang mabibigat na pagbuhat, bawal ang pagbuhat nang nakataas sa ulo, bawal ang mga biglaang paggalaw (jerking movements)
  • Iwasang tumulak paitaas mula sa upuan o kama gamit ang braso na inoperahan sa unang anim na linggo: ang acromion ay pinanipis at dapat iwasan ang forceful loading habang ito ay nag-remodel

Mga Pamantayan para sa Pag-progress

  • Ang sakit ay kontrolado nang maayos gamit ang simpleng analgesia
  • Ang pamamaga ay humuhupa at ang mga sugat ay magaling na o gumagaling nang walang problema
  • Komportableng active-assisted movement, na may active movement na bumabalik sa ibaba ng taas ng balikat

Yugong II — Pagbawi ng saklaw ng galaw at pagsisimula ng lakas (Linggo 2–6)

Ang yugong na ito ay tungkol sa pagbawi ng natitirang galaw at pagsisimula sa pagpapatibay ng lakas. Unahan ng mga ehersisyo ang pag-unlad mula sa mga galaw na may tulong patungo sa aktibong paggalaw ng braso sa lahat ng direksyon, kung saan karamihan sa mga publikadong protokol ay inaasahang may buo o halos buong saklaw ng galaw sa loob ng anim hanggang walong linggo. Ang pagpapalakas ay nagsisimula nang dahan-dahan: unang walang bigat, pagkatapos ay may mga elastic band at napakagaan na mga bigat para sa mga kalamnan ng rotator cuff at scapula. Maraming tao ang nakakakita ng tulong mula sa init bago ang ehersisyo at yelo pagkatapos nito. Ang katamtamang gawain (magaan na pag-angat sa ilalim ng taas ng balikat) ay karaniwang maaaring gawin sa yungong ito, na pinamumunuan ng iyong pisioterapeuta.

Para sa iyong pisioterapeuta:

Mga Layunin

  • Buong, o halos buong, aktibong saklaw ng galaw sa lahat ng mga plano sa paligid ng linggo 6–8
  • Mabawi at mapabuti ang lakas ng rotator cuff at scapula
  • I-normalize ang ritmong scapulohumeral at kontrol neuromuskular
  • Patuloy na pampahina ng sakit

Pamamahala

  • Pag-unlad ng saklaw ng galaw sa lahat ng mga plano, kasama ang internal rotation sa likod ng likod na may banayad na posterior capsular stretching
  • Glenohumeral joint mobilisation (inferior, posterior at anterior glides) kung kinakailangan
  • Isotonic program na nagsisimulang walang bigat (shoulder elevation, prone rowing, prone horizontal abduction, prone extension hanggang neutral, sidelying external rotation, abduction hanggang 90°), pagdaragdag ng magaan na bigat (humigit-kumulang 0.5–1 kg) pagkatapos ng isang linggo ng mga repitisyong walang sakit at maayos na kontrolado
  • External at internal rotation na may elastic tubing; pag-unlad patungo sa mga gawain sa rotation sa mas mataas na posisyon ayon sa kakayahang tanggapin ng kaginhawaan
  • Kontrol neuromuskular ng scapula at gawain ng lower trapezius; kondisyon ng trunk, core at lower-limb
  • Gawaing pang-endurance ng upper-limb; init bago at yelo pagkatapos ng mga sesyon ayon sa kagustuhan

Mga Paalala

  • Iwasan ang mga gawaing may bigat sa saklaw ng impingement na nakakapagdulot ng sakit; maaaring mahirap ang mga ehersisyo, ngunit hindi dapat muling magdulot ng sakit bago ang operasyon
  • Huwag itarget ang supraspinatus o mid-deltoid loading hanggang sa ito ay walang sakit, at iwasan ito kung ito ay nagdudulot ng sakit sa pahinga o sa gabi
  • Patuloy na iwasan ang pagtulak pataas sa pamamagitan ng operadong braso at mabigat o overhead lifting hanggang anim na linggo

Mga Kriteryo para sa pag-unlad

  • Buong, walang sakit na saklaw ng galaw na may minimal na tenderness
  • Lakas ng rotator cuff na humigit-kumulang 4/5 sa manual testing, na may mahusay na kontrol ng scapula

Yugong III — Pagpapalakas (Linggo 6–12)

Kapag bumalik ang iyong galaw, ang atensyon ay lumilipat sa lakas, tibay, at kontrol. Ang pagsasanay na may resistensya ay unti-unting nagbabago mula sa mga rubber band papunta sa mga pataba, at mas dinamikong ginagawa ang mga ehersisyo, kabilang ang pagsisimula ng kontroladong plyometric work para sa mga nagbabalik sa isport, at unti-unting pagbabalik sa pagsasanay. Karaniwang muling sisimulan ang paglangoy mula sa anim na linggo (una ang breaststroke, at freestyle kapag komportable na), at ang medium work (magaan na pagtatayo sa ibaba ng taas ng balikat) ay karaniwang kayang gawin mula sa anim na linggo. Isang interval na programa para sa pagbabalik sa isport ay karaniwang nagsisimula sa linggo 10–12 kapag natupad ang mga kriteryo sa lakas.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Pagbutihin ang lakas, power, at tibas ng shoulder complex
  • I-optimize ang neuromuscular control, proprioception, at movement patterning (walang shoulder hitching)
  • Ihanda ang sarili para sa unti-unting pagbabalik sa isport at mas mabigat na trabaho

Pamamahala

  • I-progress ang isotonic program: isometrics → elastic bands → weights; rotator cuff, deltoid, at scapular stabilisers sa 2–3 sets ng 8–12 repetitions
  • Ipakilala ang eccentrically resisted work, closed-chain exercises, at rhythmic stabilisation; proprioceptive work kabilang ang weight-bearing at four-point kneeling
  • Mga gawain sa plyometric: dalawang-kamay na drills (chest pass, side-to-side throws) na nagpo-progress papunta sa isang-kamay na drills (wall dribbles, throwing drills) sa dulo ng yugong
  • Magsimula ng interval sports program sa linggo 10–12 kung natupad ang mga kriteryo
  • Magpatuloy sa core at conditioning work; cryotherapy kung kinakailangan

Mga Paalala

  • Ang mga ehersisyo ay dapat mahirap ngunit sa pangkalahatan ay walang sakit; bumalik sa anumang gawain na nagdudulot ng resting o night pain
  • Ang mabigat na pagtatayo at patuloy na overhead loading ay hintayin hanggang sa humigit-kumulang tatlong buwan

Mga Kriteryo para mag-progress

  • Buong, walang sakit na active range of motion (humigit-kumulang katumbas ng kabilang panig)
  • Lakas na lumalapit sa kabilang panig (ang mga published na kriteryo ay nagsisimula sa 70% para pumasok sa dynamic training, papunta sa 90% para sa pagbabalik sa isport)
  • Walang sakit o tenderness kasabay ng progressive loading

Yugong IV — Pagbabalik sa buong aktibidad (Linggo 12 pataas)

Ang huling yugong ay isang unti-unting pagbabalik sa mabibigat na trabaho, mga gawain sa itaas ng ulo, at isport. Ang mabibigat o paulit-ulit na pag-angat at matagal na pagtatrabaho sa itaas ng antas ng balikat ay karaniwang muling sisimulan mula sa tatlong buwan na. Ang pagbabalik sa kompetisyong isport (lalo na sa mga isport na nangangailangan ng pagtaas ng kamay sa itaas ng ulo) ay nakabase sa pagtupad sa mga pamantayan imbes na sa kalendaryo: buong galaw na walang sakit, lakas na malapit na sa kabilang panig, at kumpiyansa sa mga drill na espesipiko sa isport. Karaniwang patuloy na umuunlad ang balikat nang mahabang panahon pagkatapos ng yugong na ito; ang mga publikadong gabay ay naglalarawan ng pag-unlad na tumatagal hanggang isang taon.

Para sa iyong pisyikal terapeuta:

Mga Layunin

  • Unti-unting pagbabalik sa mabibigat na trabaho, mga gawain sa itaas ng ulo, at isport
  • Panatilihin ang saklaw ng galaw, lakas, at kontrol sa pangmatagalan

Pamamahala

  • Patuloy na ang programang pang-palakasan, pag-angat sa mga gawain sa gym at espesipiko sa isport ayon sa kakayahang tanggapin
  • Patuloy na ang programang pang-isport na may interval, na may unti-unting pagbabalik sa paghahagis at iba pang mga isport sa itaas ng ulo
  • Sariling pamamahala ng mga stretch ng kapsula at mga ehersisyong pang-maintenance kung kinakailangan

Mga Paalala

  • Ang pag-unlad ay nananatiling nakabase sa sintomas; kung bumalik ang sakit, bawasan ang bigat, ibalik ang komportableng galaw, at muling buuin

Mga Pamantayan upang magpatuloy

  • Buong saklaw ng galaw na walang sakit
  • Sapat na lakas at pagsusuri ng fungsional (humigit-kumulang 90% ng kabilang panig ayon sa mga publikadong pamantayan para sa pagbabalik sa isport)
  • Sapat na klinikal na pagsusuri

Pagkatapos ng iyong protocol

Ang mga yugto sa itaas ay naangkop mula sa mga publikad na rehabilitation protocol at gabay para sa mga pasyente para sa arthroscopic subacromial decompression: OrthoIndy, Sports Surgery New York, Gundersen Health System Sports Medicine, Twin Cities Orthopedics, Oxford University Hospitals NHS Foundation Trust at Royal Berkshire NHS Foundation Trust. Ang mga saklaw ng linggo ay karaniwan imbes na nakatakda, at ang iyong patuloy na rehabilitasyon ay indibidwal na pinamumunuan ng iyong pisioterapeuta, na nagtatrabaho kasama ang klinik, batay sa kung paano gumagaling ang iyong balikat. Ang pahinang ito ay nagtatrabaho kasama ng pangkalahatang payo sa paggaling ng klinik; tingnan ang pagmamana ng post-operative na sakit at pag-aalaga sa sugat. Para sa operasyon mismo at sa kondisyon na ito ay nagpapagamot, tingnan ang subacromial decompression. Ang ebidensya sa likod ng protocol na ito (kabilang kung paano ito angkop sa ebidensya ng trial tungkol sa subacromial surgery) ay buod sa seksyon ng ebidensya, na available bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Arthroscopic Subacromial Decompression (Acromioplasty) — Post-operative Rehabilitation

Topic scope: Post-operative rehabilitation after isolated arthroscopic subacromial decompression (ASD / acromioplasty ± bursectomy). When a decompression is performed together with a rotator cuff repair, the repaired tendon sets the (slower) pace and the rotator-cuff-repair protocol takes priority — this page is for the isolated decompression.

Defining principle of this rehab: a subacromial decompression shaves bone and clears bursa — it repairs nothing that needs protecting. So (like a debridement, and unlike a cuff repair or stabilisation) the rehab is an early-movement pathway: a short sling for comfort only, weaned within days, motion and normal light use from day one, and a rapid return of range and function. The aim is to settle the post-operative flare and keep the shoulder moving while it quiets down — rehabilitation, not rest, does the work.

A. THE PROCEDURE & ITS EVIDENCE CONTEXT (important)

Arthroscopic subacromial decompression removes the subacromial bursa and shaves the under-surface of the acromion to "make room" for the rotator cuff, on the impingement model of subacromial pain.

The efficacy of the bony decompression itself is one of the most debated questions in shoulder surgery, and the rehabilitation context cannot be stated honestly without it:

  • CSAW (Beard et al, Lancet 2018; n=313, 3-arm) — a placebo-controlled surgical RCT. Decompression gave no clinically important benefit over arthroscopy-only (placebo) surgery, and both surgical arms were only marginally better than no treatment — a difference below the pre-specified minimal clinically important threshold.
  • FIMPACT (Paavola et al, BMJ 2018) — a second placebo-controlled RCT: no benefit of ASD over diagnostic arthroscopy, and neither was superior to a structured exercise programme at 2 years.
  • Cochrane review (Karjalainen et al, 2019) — high-certainty evidence that subacromial decompression provides little or no clinically important benefit over placebo for pain, function, or quality of life.

The practical consequence is that structured exercise/physiotherapy is first-line for subacromial pain, and ASD is now a selective operation — reserved for patients who have failed an adequate non-operative programme or who have a specific mechanical lesion. This does not make a well-selected decompression valueless, but it explains why the post-operative emphasis is on early movement and rehabilitation, which is what reliably drives recovery.

B. POST-OPERATIVE PHASED TIMELINE (isolated decompression)

A nerve block is commonly used (numb arm for some hours — start analgesia before it wears off). Keyhole wounds; desk-based work commonly resumes within ~2 weeks.

Phase Window Sling ROM / use Strengthening Notes
I — Early movement Week 0–2 Comfort only, off within days (gone by ≤ 2 wk) Hand/elbow immediately; pendulums + assisted motion as comfort allows; normal light daily use from day 1 — Settle pain/swelling; ice; analgesia before exercise. No driving while in sling (typically back ~1–3 wk once out of sling + safe emergency stop)
II — Restore range / start strength Week 2–6 Off Progress to full active ROM all planes Begin gentle cuff + scapular strengthening Range comfortable below shoulder height; most daily activity resumed
III — Strengthening Week 6–12 Off Full Progressive cuff/scapular loading, band → light weight Heavier and overhead loading built gradually
IV — Return to full activity Week 12 + Off Full Advanced/sport-specific Full unrestricted activity typically ~3 months

There is no construct-protection branch in the isolated decompression — the only branch is if a rotator cuff repair was also done, which converts recovery to the protected cuff-repair pathway.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Does the bony decompression add anything? Two placebo-controlled RCTs (CSAW, FIMPACT) and a Cochrane review say it adds little or nothing over placebo or exercise for subacromial pain. Strong (RCT/SR). → exercise-first, selective surgery.
  2. Decompression added to a cuff repair — multiple RCTs show no added benefit of routine acromioplasty at the time of arthroscopic cuff repair. Moderate–strong.
  3. The post-operative rehab protocol itself — consensus/expert (institutional protocols), no defining rehab RCT; phase timings are typical, not trial-derived. Weak/consensus.

(Patient-facing note: the efficacy debate belongs in this clinician evidence section, not the patient protocol page — surfaced here for the surgeon's awareness.)

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (RCT / SR): ASD provides little/no benefit over placebo surgery or exercise (CSAW Lancet 2018; FIMPACT BMJ 2018; Cochrane Karjalainen 2019); no benefit of added acromioplasty at cuff repair.
  • MODERATE: early-motion rehabilitation after isolated decompression (institutional cohorts / consensus protocols, consistent ~3-month recovery).
  • WEAK / CONSENSUS: the specific phase/timeline structure of the post-op protocol.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Is acromioplasty justifiable? Orthop Traumatol Surg Res. 2019. DOI: 10.1016/j.otsr.2019.10.002
  • Indications for Arthroscopic Subacromial Decompression: a Level V evidence clinical guideline. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.012
  • The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness rotator cuff tears. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.11.022
  • Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty (RCT). Am J Sports Med. 2014. DOI: 10.1177/0363546514529091
  • A comparative study of arthroscopic débridement versus repair for Ellman grade I partial cuff tears. J Shoulder Elbow Surg. 2020. DOI: 10.1016/j.jse.2020.03.006

Landmark trials / reviews (URLs)

  • Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): placebo-controlled 3-group RCT. Lancet. 2018. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext
  • Paavola M, et al. (FIMPACT) Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled trial. BMJ. 2018;362:k2860. https://www.bmj.com/content/362/bmj.k2860
  • Karjalainen TV, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev. 2019. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005619.pub3/full

Published rehab protocols (basis for the phase structure)

  • Kendall C. Arthroscopic Subacromial Decompression Physical Therapy Protocol. OrthoIndy. https://www.orthoindy.com/wp-content/uploads/Arthroscopic-Subacromial-Decompression.pdf
  • Strauss EJ. Rehabilitation Protocol: Arthroscopic Subacromial Decompression / Distal Clavicle Excision. Sports Surgery New York. https://www.sportssurgerynewyork.com/pdf/arthroscopic-subacromial-decompression-distal-clavicle-excision-rehab-protocol.pdf
  • Gundersen Health System Sports Medicine. Subacromial Decompression / Acromioplasty Rehabilitation Program. https://www.gundersenhealth.org/sites/default/files/2022-06/Sports-Medicine-Protocol-Subacromial-Decompression-Acromioplasty.pdf
  • Meisterling RC. Arthroscopic Subacromial Decompression Rehabilitation. Twin Cities Orthopedics. https://tcomn.com/wp-content/uploads/2016/06/Arthroscopic-Subacromial-Decompression-Rehabilitation.pdf
  • Scott-Dempster C, Harper J. Outpatient Post-operative Physiotherapy Guidelines: Sub-Acromial Decompression. Oxford University Hospitals NHS FT. https://www.ouh.nhs.uk/media/zidppie2/sub-acromial-decompression.pdf
  • Royal Berkshire NHS FT. Arthroscopic subacromial decompression and/or ACJ excision: discharge advice. https://www.royalberkshire.nhs.uk/media/smegtn3c/arthroscopic-subacromial-decompression-and-or-acromioclavicular-joint-excision-discharge-advice_jul24.pdf

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Using Creative Commons Public Licenses

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.