Shoulder adolescent MDI, post-op from arthroscopic capsulolabral tightening / balanced capsulorrhaphy

You or your child had just undergone shoulder arthroscopic stabilization for multidirectional instability (MDI) with Kemble Wang. This means that the shoulder joint was unstable and "loose" in multiple directions, usually with a large/stretchy joint capsule. The condition is more likely to occur in younger adults or adolescents with a history of stretchy joints (ligamentous laxity). Symptoms include instability, frequent dislocations on minor movements, or even just pain and a vague discomfort.

 

During the procedure Kemble would have arthroscopically "tightened" your shoulder capsule with sutures and bioabsorbable anchors which has the effect of stabilizing the shoulder. There would be several key-hold wounds that are closed with absorbable sutures and dressed with dermabond (skin glue) and water-resistant dressings. 

The following is a schematic diagram of an arthroscopic stabilization for MDI, involving capsulolabral tightening and capsular shift:​​

The following is your physiotherapy prescription: 

 

  • Weeks 0-6 postop

    • Sling x 4 weeks

      • Pendulums at 3 weeks postop

      • Active, AAROM in shoulder flex/ex OK

      • Full Elbow and wrist ROM OK

      • No Shoulder ER past 0 degrees

      • No shoulder abduction

      • Deltoid isometrics OK

  • Weeks 6-10 postop

    • Go SLOW

    • DO NOT PUSH through pain to regain motion

    • No Assisted shoulder ER past 0 degrees

    • No Forward flexion > 90 degrees

    • No Abduction > 90 degrees|

    • PROM OK

    • Pool exercises for AAROM in flex/ex, horizontal Adduction

    • OK to start light vertical rows

    • Exercises should be narrow grip and in front

    • No flies or bench press

    • Can do AROM, strength and isometrics

  • Weeks 10-16 postop

    • Continue PT as above

    • Go SLOW, do not push through pain

    • Advance motion slowly

    • PRE’s for biceps, triceps, scapula

    • No ER PRE’s

  • 4 months postop

    • AROM, AAROM to improve ER

      • Goal 10-20 degrees less than other side

    • Keep PRE’s below horizontal plane for non-throwers

  • 6 months postop

    • Return to sports / full activity / swimming for non-throwers

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for professional medical advice.