Shoulder impingement that does not improve after injection or therapy sometimes results in arthroscopic surgery known as acromioplasty, where bone is shaved down at the end of the acromion. This surgical procedure is also known as arthroscopic subacromial decompression (ASD). Patients recovering from shoulder arthroscopy are sometimes sent home after surgery without formal physical therapy; usually the orthopedic surgeon recommends that their post-operative patients only perform simple range of motion (ROM) exercise.
Few studies have directly compared the effectiveness of home-based exercise and supervised physical therapy after arthroscopic acomioplasty. Swedish researchers randomly assigned 36 patients to either supervised physical therapy or home exercise for 12 weeks after arthroscopic acromioplasty. The home exercise group performed active and active-assisted ROM exercises, while the physical therapy-supervised group progressed from active and active-assisted ROM exercises to strengthening exercises for the rotator cuff and scapular stabilizers. They used elastic resistance bands and weights during 4 phases of the program.
After 12 weeks, the physical therapy group had significantly greater shoulder function measured by the Constant-Murley shoulder test. At 6 months, the physical therapy group scored significantly higher on self-reported function. The researchers concluded, With regard to shoulder function and pain in patients with ASD, physical therapy-supervised rehabilitation focusing on strengthening exercises for the rotator cuff and scapular stabilizers is superior to instruction for home exercises with a focus on increasing mobility.
Post-arthroscopic physical therapy programs including Thera-Band elastic bands are superior to simple home-based range of motion programs. Further research should examine a complimentary program where both patient groups perform similar exercises, but at different levels of physical therapy supervision.
REFERENCE: Holmgren T, et al. Supervised strengthening exercises versus home-based movement exercises after arthroscopic acromioplasty: a randomized clinical trial. J Rehabil Med. 2012 Jan;44(1):12-8.
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