Rehabilitation Guidelines Following Arthroscopic Shoulder Stabilisation Surgery for Traumatic Instability - A Delphi Consensus

Elaine Willmore, Marcus Bateman, Natasha Maher, Rachel Chester, Joel O’Sullivan, Ian Horsley, James Blacknall, Jo Gibson, Anju Jaggi

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There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice.

Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement.

11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined “safe zone.” Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks.

Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient’s confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score.

This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS.
Original languageEnglish
Early online date16 May 2024
Publication statusE-pub ahead of print - 16 May 2024

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