Home Therapeutic Exercise Program for patients undergoing Arthroscopic Acromioplasty

The primary researcher will visit the patient's room on the day of the surgical intervention to teach and supervise the exercises that the patient will do at home until the date when hospital rehabilitation begins. Patients are immobilized for an estimated 7 days after intervention with a medical sling, which can be removed 48 hours after intervention if there has been rotator cuff tendon repair or 24 hours if there hasn't, during night rest and during the day while the patient is doing the exercises. Exercises will be done without surpassing pain limits and at least three times a day. The bouts will consist of two series of ten repetitions of each exercise. Patient will rest when pain or muscular fatigue appear and then retake the exercises till they complete the whole bout. Patients were advised to use ice in order to lower inflammation for the first days. Home exercises consist of: -Free active exercise of neighboring joints Active movement of the wrist, fingers, hand, and elbow in order to maintain muscular balance and range of motion. Patients will be advised to pay special attention to wrist flexo-extension, hand closing and opening, and lastly, elbow flexo-extension and prono-supination. -Pendular exercise. Opposite leg to the intervened shoulder: one step forward, trunk flexion of 50. The intervened shoulder is relaxed, and the patient does a pendular flexo-extenstion movement followed up by clockwise and anticlockwise circular movements. -Self-assisted shoulder exercise Patient in a supine position (when pain remits, this exercise will be done in a seated position). Hands are intertwined with elbows extended. Patient does active shoulder flexion with the healthy upper limb, which will help the movement of the intervened limb. When it reaches the pain limit, both limbs go back to the base position. -Shoulder rotation exercise with a supported elbow. Patient seated with 90º of hip and knee flexion. Neutral prono-supination with elbow on a stable surface and close to the body. Patient does an active movement sliding the forearm and making internal and external shoulder rotation. -Finger ladder exercise on the wall. The patient is seated during the first days and then in a standing position when the pain remits. Elbow extended and body parallel to the wall. Patient simulates a ladder on the wall that they climb with their second and third fingers, making a shoulder flexion, and when pain does not allow more movement, patient does the inverse movement without taking the fingers off the wall too harshly. -Hand-to-back movement exercise. Patient in a standing position. Patient takes the hand of the intervened limb behind their back and to the opposite side to the point where pain allows it. Following that, the patient gently returns to his or her original position. -Active shoulder abduction. Patient seated with lumbar support with 90º of hip and knee flexion, feet on the ground. Patient does a shoulder abduction till the pain appears, then it goes back to the base position softly, avoiding harsh movements. When the limb reaches 90º, it is indicated to mix the movement with external rotation. The patient can combine the abduction with several degrees of shoulder flexion, and when, at a later stage, they gain more range of movement, they will try to touch their head with their hand. -Active shoulder extension. Patient standing parallel to the wall with their back facing the wall. Patient does an active shoulder extension with the intervened shoulder trying to touch the wall with the palm of their hand. -Active shoulder adduction. Patient seated with an elbow flexion of 90º and neutral prono-supination of the intervened upper limb. A towel is placed between the body and the arm. Patient presses the elbow against the towel and body while descending the shoulder down. This contraction should last 5 seconds. The patient will rest between each contraction. After teaching the exercises to the patient, the main researcher will provide them with a manuscript with general and specific recommendations and reinforce the teaching with a table of the exercise with pictures. In addition, the main researcher wrote their telephone number to clarify any doubts that arise. Finally, each patient was given a follow-up sheet where they record, after the day of the surgery, the number of times they have done the exercises each day and the time of the day when they did it to keep track of their adherence to the exercise program. The patient will do at home until the date when hospital rehabilitation begins, anticipated to be 30-45 days. The manuscript provided to participants was designed specifically for this study and is not public until the full study is published.