Subacromial Decompression — / Distal Clavicle Excision / Biceps Tenotomy or Tenodesis

Sutter Health / Palo Alto Medical Foundation · Kevin Roth MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling for comfort only Phase I (remove as desired for hygiene/exercises/activities); wean from sling Phase II (wks 3-6); biceps tenodesis modifier: no active elbow flexion until wk 3, no elbow strengthening until wk 8

Timeline & Phases

Phase I (wks 1-3): sling for comfort (remove as desired), AROM and PROM as tolerated, Codman's pendulums, scapular exercises, elbow/wrist/hand ROM, ball squeezes | Phase II (wks 3-6): wean from sling, progress PROM, pool therapy for AAROM/AROM, supine AAROM progressing to AROM, light scapular strengthening (retraction/protraction/shrugs/setting), gentle joint/soft tissue mobilization | Phase III (wks 6-12): no sling, full ROM without discomfort, RC strengthening exercises, supine → seated → standing AROM, pool AAROM, lat/biceps/triceps/pecs/rhomboids/deltoids strengthening, theraband exercises, sport/job-specific activities | Phase IV (wks 12-24): full ROM, progress to tolerance, no restrictions

Notes

Published 2024; covers three procedures in one protocol: arthroscopic subacromial decompression, distal clavicle excision, and biceps tenotomy/tenodesis; sling is comfort-only (not required) Phase I — the least restrictive of Roth's shoulder protocols; biceps tenodesis modifier: no active elbow flexion until wk 3 Phase I, begin active elbow flexion against gravity Phase II, no elbow strengthening until wk 8; Phase IV has no restrictions; Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD

Published

2024