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:​​

arthroscopic MDI stabilisation.png

The following is your physiotherapy prescription: 

 

  • Weeks 0-2 postop

    • Sling full time

    • NO pendulars​
    • elbow/wrist ROM ok
    • scapular shrugs ok unless pre-existing scapular dyskinesia
  • ​Weeks 2-6 post op​

    • Pendulums start at 2 weeks postop

    • sling most of the time except exercises

    • Active, AAROM in shoulder flex/ext plane, but not past 45 deg

    • Active, AAROM shoulder ER but not past 0 deg

    • 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