OrthoSpace InSpace™ Implantation Rehabilitation Guidelines

OrthoSpace InSpace™ Implantation Rehabilitation Guidelines

Introduction

The rehabilitation program following OrthoSpace InSpace™ Implantation must be individualized for each patient. Exercises should always be performed without pain. Specific restrictions and instructions will be provided post-operatively. If these details are not provided, contact the consultant’s secretary.

These guidelines complement the routine protocols for either Arthroscopic Subacromial Decompression (ASD) or Rotator Cuff Repair, depending on the surgical procedure performed.

Post-Surgery Rehabilitation Phases

Phase 1: 1-14 Days

Goals:

• Pain Management & Inflammation Control:
  • Use of analgesics, NSAIDs, ice, sling, and passive movement to manage pain.
  • Focus on posture and shoulder girdle control/setting.
• Range of Motion (ROM):
  • Passive ROM (PROM) and Active-Assisted ROM (AAROM) should be initiated as tolerated (forward flexion and abduction to <60°).
  • Pendulum movements should be started, ensuring scapular humeral rhythm (SHR).
  • External Rotation (ER) and Internal Rotation (IR) should be performed in neutral.
• Upper Limb Mobility:
  • Perform wrist, elbow, and neck ROM exercises as required.

Precautions:

• Sling Use: Typically for 2 weeks.
• Keep wounds clean and dry.
• Avoid excessive movement or strain.

Milestones:

• Pain and inflammation are well-controlled.
• Full active joint ROM achieved.
• Good scapular setting maintained.

Phase 2: 15 Days - 8 Weeks

Goals:

• Continue managing pain, inflammation, and muscle inhibition.
• Transition from sling use when comfortable.
• Scar massage once stitches are removed.
• Gradually restore PROM and AROM (as tolerated, without pain).
• Re-establish dynamic shoulder stability (use SHR and the Anterior Deltoid Programme (ADP) to assist the rotator cuff).
• Strengthening Exercises: Begin with isometrics, progressing to proprioception, and core strengthening as tolerated.
• Introduce light, non-repetitive functional activities.

Precautions:

• As the InSpace™ Implant dissolves (around 6-8 weeks), there may be increased symptoms; focus on plateau exercises to minimize discomfort.

Milestones:

• Minimal pain and inflammation.
• Return to pre-operative sleep patterns.
• Good scapular setting maintained.
• Full pre-operative ROM achieved.

Phase 3: 8 - 14 Weeks

Goals:

• Full PROM with multi-directional stretching into the end range as tolerated.
• Continue restoring AROM.
• Strengthening Progression: Continue isometric strengthening, moving to isotonic and dynamic exercises for the shoulder and upper limb.
• Gradually introduce sport-specific exercises.

Precautions:

• Avoid heavy, repetitive, or prolonged overhead activities, and refrain from power activities for at least 3 months.

Milestones at 6 Weeks:

• Minimal pain, inflammation, and muscle inhibition.
• Good SHR with AROM.

Milestones at 14 Weeks:

• Resolved pain, inflammation, and muscle inhibition.
• AROM with good SHR to 100% of pre-operative range.

Phase 4: 3 - 9 Months

Goals:

• Maintain Full PROM and continue stretching into the end range.
• Full pre-operative AROM with good SHR.
• Progress shoulder strengthening and scapular stabilisation exercises.
• Gradually increase the intensity of functional activities and sport-specific exercises.

Milestones at 4 Months:

• Achieve full, pain-free motion with good SHR.

Contact Information

• Consultant Secretary: 07810 356433
• Sulis Hospital Physiotherapy: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

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