WEAVER-DUNN

PROTOCOL
PHYSIOTHERAPY LED POST OPERATIVE SHOULDER CLINIC

COMPILED BY: TENDAYI MUTSOPOTSI BSc. HPT (Hons) MSc. ORTHO-MED MCSP MSOM
APPROVED BY: MR ANDREW SANKEY ORTHOPAEDIC CONSULTANT SURGEON

Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)

 Weaver-Dunn Post-Operative Rehabilitation Protocol

The purpose of this protocol is to provide the physiotherapist with a guideline for the postoperative rehabilitation course of a patient that has undergone and acromioclavicular joint stabilization following a dislocation. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patients post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)
Procedure Usually done as an open procedure where the dislocation is reduced. The coraco-acromial ligament is detached from the acromion and grafted into lateral end of the clavicle. The graft is protected in the early stages sutures passing over the clavicle attached to anchors in the coracoid. The patient may experience a small pop when the sutures give in at about 6 weeks. Please Note: graft is vulnerable to stretching between 6 and 12 weeks and will regain its maximum strength around 36 weeks post procedure. Goals Regain FROM Achieve good static and dynamic scapula control

Precautions Avoid caudal and axial loading Sling maintained for about 6weeks Day 1 No active or passive shoulder mobilization Home cryotherapy advice Commence scapula setting and postural input (forms mainstay of rehabilitation) Advise re use of sling and pendular positioning for washing under arm only, not as an exercise Fold arms, rest on pillow/arm chair while in sling if positioning the arm in order to unload the ACJ and shoulder girdle Emphasise re protection of the graft i.e. avoiding loading for 12 weeks Commence re cervical, elbow, wrist and hand exercises

Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)

Week 1 Continue protection in immobilizer or sling Patient out of immobilization for elbow, wrist and hand exercises Putty exercises May begin gentle Codmans exercises May begin bicep/triceps isometrics May begin PROM to pt. tolerance

Week 2 Check wound and remove sutures Continue sling Continue Codmans exercises Continue PROM May add light weight to hand and wrist May do weighted elbow exercises if supported May begin AAROM Week 3 Continue AAROM and PROM in comfort range May begin AROM Start low level isometric cuff Week 4-6 May discontinue sling and emphasize importance of posture AA Flexion in supine to 90 AA External rotation in supine Progress scapula exercises Precautions Avoid HBB and axial loading e.g. carrying shopping Week 8 Progress to FAROM in supine and 90 in standing Start phase I & II hands behind back Start hands behind head Progress scapula control and strengthening Continue being cautious about axial loading to protect repair

Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)

Week 12 Start Phase III and FAROM in standing Guidelines to return to activity Driving 8 weeks to stress on the repair Work 2 weeks (if able to work in sling) Manual labour 16-24 weeks Non contact sport 24 weeks Contact sport 36 weeks Milestone driven These are milestone driven guidelines designed to provide an equitable rehabilitation service to all of our patients. They will also limit unnecessary visits to the outpatient clinic here at Chelsea & Westminster by helping the patient and therapist to identify when specialist review is required. If patients are progressing satisfactorily and meeting milestones, there is no need for them to attend clinic routinely. Failure to progress or variations from the norm should be the main reason for clinic attendance. Both patients and therapists can book clinic visits by contacting the numbers given further on in this document. Clinic follow-up schedule post-op: 2weeks 6weeks 12 weeks 16-24 weeks (only if necessary)

Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)

Failure to progress If a patient is failing to progress, then consider the following: Possible problem Pain inhibition Action Adequate analgesia Keep exercises pain-free Return to passive ROM if necessary until pain controlled Progressing too quickly hold back If severe night pain/resting pain refer to Shoulder Unit Increase or reduce physiotherapy/ (HEP) (max 2-4x/day) for few days/weeks and assess difference Ensure HEP focuses on key exercises and link to function Decrease activity intensity Assess and treat accordingly Passive ROM may need improving Assess and treat accordingly Ensure passive range gained first Consider isometrics through range Rotation dissociation through range with decreasing support and increasing resistance Ensure not progressing through Therabands too quickly Work on scapula stability through range without fixing with pec major/lat dorsi Work on improving core stability Maintain passive ROM as able Use physiological and accessory mobilisations, taking into account end feel and tissue healing times Injection can be useful Please contact Mr. Sankey or myself immediately

Patient exercising too vigorously Patient not doing home exercise programme (HEP) regularly enough

Returned to activities too soon Cervical/thoracic pain referral Unable to gain strength Altered neuropathodynamics Poor rotator cuff control

Poor scapula control Poor core stability Secondary frozen shoulder

Subacromial Bursitis Infection

Also consider possible complications noted previously Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)

 It is essential you contact us if you have any concerns: THE SHOULDER TEAM Mr. Andrew Sankey (Shoulder Consultant Surgeon) 020 8746 8545 Tendayi Mutsopotsi (Specialist Shoulder Therapist) 020 87468404 Mr. Austin Navin (Secretary) 020 8746 8545

Weaver-Dunn Rehabilitation Protocol 2010 Tendayi Mutsopotsi (Shoulder Physiotherapist)