Other Shoulder Treatments

AC joint stabilisation

What is AC joint stabilisation?

AC joint stabilisation is a surgical treatment for acromioclavicular (AC) joint dislocations. The AC joint is at the top of the shoulder, where the top of the scapula (the acromion) joins the collarbone (the clavicle).

What is involved and what to expect with AC joint stabilisation?

Before surgery

‘Pre-habilitation’ is recommended to build strength in the muscles that support your shoulder. Starting physiotherapy before surgery tends to improve your recovery after surgery.

Day 1 to 3 weeks

For the first 3 weeks you will wear a sling, but you will still be able to start your rehabilitation physiotherapy program.

Before you leave hospital, your therapist will teach you how to keep your armpit clean and some initial exercises including:

  • postural awareness and scapular setting
  • core stability exercises, as appropriate
  • proprioceptive exercises (minimal weight bearing below 90 degrees)
  • active assisted flexion, as comfortable
  • active assisted external rotation, as comfortable

It’s important not to force or stretch your shoulder at this time as it may cause pain and delay healing.

3–6 weeks

During this time, you will wean off wearing the sling and progress your exercises as directed by your physiotherapist. By week 6, you should be able raise your arm to your pre-surgery level.

If you have an office-style job, you will be able to return to work during this period, if you can manage it.

6–12 weeks

Your physiotherapy program will continue to work on regaining scapula and glenohumeral stability, aiming to achieve shoulder joint control rather than range. Your program will involve:

  • gradually increasing your range of motion
  • strengthening exercises
  • increaseing proprioception through open and closed chain exercise
  • core stability exercises
  • incorporating sports-specific rehabilitation
  • plyometrics and pertubation training

By 6–8 weeks you should be able to resume driving and start swimming breaststroke for exercise.

By 12 weeks you can expect at least 80% range of external rotation compared to your other side and normal movement patterns throughout the range. At this stage, you might be able to resume manual work, swim freestyle, play golf, lift heavier objects and play contact/impact sports. Your surgeon will be able to advise you on what is appropriate at the time.

Biceps tenodesis

What is biceps tenodesis?

Biceps tenodesis is a surgical procedure used to treat a damaged and partially torn long head of biceps tendon. The tendon is transposed from its origin on the glenoid to the humerus, where it is secured into place with screws or anchors.

What is involved and what to expect with biceps tenodesis?

Before surgery

‘Pre-habilitation’ is recommended to build strength in the muscles that support your shoulder. Starting physiotherapy before surgery tends to improve your recovery after surgery.

After surgery

Day 1 to 3 weeks

For the first 3 weeks you will wear a sling, but you will still be able to start your rehabilitation physiotherapy program.

Before you leave hospital, your therapist will teach you how to keep your armpit clean and some initial exercises including:

  • postural awareness and scapular setting
  • core stability exercises, as appropriate
  • finger, wrist and forearm movements
  • active elbow flexion and extension in standings, as tolerated
  • active shoulder movement, as tolerated
  • active assisted external rotation, as comfortable

It’s important to avoid resisted elbow flexion and forced passive extension as it may cause pain and delay healing

3–6 weeks

During this time, you will wean off wearing the sling and progress your exercises as directed by your physiotherapist. Your program will involve:

  • exercises for kinetic chain control
  • strengthening rotator cuff muscles
  • starting to perform elbow flexion with light resistance, as tolerated

By week 6, you should have full active range of shoulder and elbow motion.

If you have an office-style job, you will be able to return to work during this period, if you can manage it.

6–12 weeks

Your physiotherapy program will continue with eccentric biceps exercises with scapula control.

By 6–8 weeks you should be able to resume driving and start swimming breaststroke for exercise.

By 12 weeks you can expect full active range of elbow and shoulder movement with dynamic scapula stability throughout range. At this stage, you resume functional activities and you might be able to resume manual work, swim freestyle, play golf, lift heavier objects and play contact/impact sports. Your surgeon will be able to advise you on what is appropriate at the time.

12 weeks +

You can now start biceps strengthening exercises.

Shoulder or clavicle fracture fixation

What is shoulder or clavicle fracture fixation?

This is surgical treatment for a broken shoulder. There are three bones in your shoulder that can be fractured:

  • the clavicle (collarbone)
  • the scapula (shoulder blade) including the socket part at the top (glenoid cavity)
  • the proximal humerus (head of the upper arm bone)

Treatment of these fractures will depend on whether the bones remain in their correct anatomical position (non-displaced) or are out of place and separated (displaced). Around 80% of shoulder fractures are non-displaced and can be treated successfully without surgery. Non-surgical treatment involves non-drug therapy (eg a sling and physiotherapy) and medication (eg anti-inflammatories).

Displaced fractures often require surgery to realign the bones and hold them together while they heal.

Do I need surgery for my shoulder fracture?

Most people do not require surgery for a shoulder fracture. But if the bones are displaced, you will probably need surgery. Your doctor will advise you of the best treatment option for your situation.

How does fracture surgery work?

The surgical procedure will depend on the location and severity of the fracture. In general, surgery will involve moving the pieces of broken bone back into the right position, removing bone fragments that can’t be replaced, and securing the bones together. Screws and plates or pins are typically used fix the bones in place.

What to expect after shoulder fracture surgery?

Day 1 to 3 weeks

Your surgeon will provide you with specific post-op advice based on your particular surgery. Generally, you can expect to wear a sling, but still start your rehabilitation physiotherapy including:

  • wrist, hand and finger exercises
  • elbow flexion and extension and rotation exercises
  • shoulder girdle exercises
  • scapula setting exercises

It’s important not to force or stretch your shoulder during these exercises, as this can cause pain and delay healing.

3–6 weeks

During this period, you will wean off wearing the sling and continue your physiotherapy with:

  • gentle isometric exercises in neutral as pain allows
  • begin active assisted exercises ensuring glenohumeral movement, not scapulothoracic

At 4 weeks you should have at least 50% of the passive range of motion that you had before surgery.

If you have an office-style job, you can return to work as soon as you can manage.

6–12 weeks

After 6 weeks you will begin:

  • to progress to full active exercises in all ranges
  • rotator cuff strengthening (pain free)
  • closed chain exercise
  • stretching the capsule
  • proprioceptive exercises

Most people can start driving again between 6–8 weeks after surgery. You can begin swimming freestyle for exercise from 6 weeks.

By 12 weeks you should have both active and passive range of motion equal to your pre-op level. At this stage, you will probably be able to resume manual work, lift heavier objects and play golf. You may also be able to resume contact/impact sports. Your surgeon will advise you about what’s appropriate for you based on your recovery.

Shoulder SLAP repair

What is a SLAP repair?

SLAP stands for Superior Labral Anterior to Posterior and it describes a type of tear to the labrum of the shoulder. The labrum is a ring of cartilage around the socket of the shoulder joint. A SLAP injury refers to a tear in the top (superior) part of the labrum, where the biceps tendon attaches.

If the symptoms of your SLAP tear do not improve with conservative therapy, you may need to have it surgically repaired.

How does SLAP repair work?

Most SLAP repair surgeries are done arthroscopically. With an arthroscope, your surgeon can examine the inside of your shoulder joint and identify the type of SLAP tear, which will determine the best type of repair. Some tears just require removing the damaged tissue. Others involve re-attaching the torn away labrum, and possibly also cutting the biceps tendon.

What to expect after SLAP repair?

Day 1 to 3 weeks

For the first 3 weeks you will wear a sling, but you will still be able to start your rehabilitation physiotherapy program.

Before you leave hospital, your therapist will teach you how to keep your armpit clean and some initial exercises including:

  • postural awareness and scapular setting
  • kinetic chain control exercises
  • exercises regain scapula and glenohumeral stability, aiming for shoulder joint control rather than range
  • passive range of motion, progressing to active assisted motion
  • closed chain exercises, as tolerated
  • active elbow flexion and extension in standings, as tolerated
  • core stability exercises with sling

3–6 weeks

By week 3 you will probably no longer be using the sling.Your exercises will progress as directed by your physiotherapist. Your program will involve:

  • active glenohumeral flexion, abduction, internal and external rotation
  • scapular stabiliser exercises
  • exercises for kinetic chain control
  • strengthening rotator cuff muscles
  • posterior complex stretching
  • increase proprioception through open and closed chain exercise

By week 6, you should have full active range of shoulder elevation.

If you have an office-style job, you will be able to return to work during this period, if you can manage it.

6–12 weeks

Your physiotherapy program will incorporate:

  • posterior capsule mobility
  • manual therapy to eliminate any stiffness, as needed
  • eccentric biceps exercises with scapula control, depending on biceps function
  • sports-specific rehabilitation

By 6–8 weeks you should be able to resume driving and start swimming breaststroke for exercise.

By 12 weeks you can expect full active range of shoulder movement with dynamic scapula stability throughout range. At this stage, you resume functional activities and you might be able to resume manual work, swim freestyle, play golf, lift heavier objects and play contact/impact sports. Your surgeon will be able to advise you on what is appropriate at the time.

12 weeks +

You can now start biceps strengthening exercises.