Rehabilitation Protocol After Shoulder Arthroscopy

Immediate Post-Operative Pain Management

The American Society of Anesthesiologists recommends aggressive multimodal pain control, including paracetamol and NSAIDs, for effective pain management and long-term functional outcomes 1, 2, 3
The use of intravenous dexamethasone is recommended as it prolongs nerve block duration, reduces analgesic requirements, and provides anti-emetic effects 1, 2, 3, 4, 5
Opioids should be reserved strictly for rescue analgesia only, and not used as scheduled medication 1, 2, 3, 4, 5
Interscalene brachial plexus block is the first-choice regional technique for initial pain control, providing superior pain control 1, 2, 3, 4, 5

The American Academy of Orthopaedic Surgeons recommends continuing scheduled paracetamol and NSAIDs for pain control during the immobilization phase 1, 2, 3, 4
Cryotherapy should be applied in the first post-operative week for pain and swelling reduction 7

The American Physical Therapy Association recommends gentle passive range of motion exercises, focusing on external rotation and abduction, to prevent adhesive capsulitis 8, 7
Exercises should be performed within a pain-free range, avoiding forced motion 8, 7
Gradually increase motion in conjunction with restoring proper joint alignment 8, 7, 9
The use of overhead pulleys should be avoided as they encourage uncontrolled abduction and can disrupt the repair 7, 9

The American College of Sports Medicine recommends continuing emphasis on external rotation and abduction, and strengthening weak muscles in the shoulder girdle, including scapular stabilizers 8, 7
Proper mechanics of the shoulder and spine should be re-established 7

The National Academy of Sports Medicine recommends progressive strengthening, focusing on rotator cuff and scapular stabilizer muscles, at 12 weeks post-operatively 7
Dynamic stabilization exercises and core and lumbopelvic strengthening should be included as part of kinetic chain rehabilitation 7

The American Orthopaedic Society for Sports Medicine recommends not returning to normal activities until achieving pain-free motion and adequate strength 7
Pain-free active range of motion in all planes, adequate rotator cuff and scapular stabilizer strength, and restoration of proper shoulder mechanics are necessary before returning to activity 7

The International Association for the Study of Pain recommends re-evaluating for complications, such as adhesive capsulitis, complex regional pain syndrome (CRPS), or repair failure, if pain persists beyond 3 months despite appropriate rehabilitation 8, 7, 9
Subacromial corticosteroid injection, botulinum toxin injections, and oral corticosteroids may be considered for persistent pain management 8, 7, 9