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Planning for Surgery
Rehabilitation Protocol:
TOTAL OR HEMI SHOULDER ARTHROPLASTY
This program is designed as a guide for both the patient and therapist for shoulder arthroplasty.
Important variables with the surgical procedure include:
- Association of a fracture
- Concomitant rotator cuff repair
- Trade-off between motion and the healing of tissue.
PREOPERATIVE PHYSICAL THERAPY:
- Preoperative orientation visit, review protocol
- Instructions on placement of immobilizer/sling and proper icing techniques.
- Instruction in home exercise program (fingers, wrist, elbow and pendulum)
- Schedule first outpatient physical therapy visit beginning 7-10 days after surgery.
POSTOPERATIVE PHYSICAL THERAPY:
Phase 1: Immediately post-op to 3 weeks
****There is no limit to active forward flexion unless otherwise instructed.****
Goals: To begin movement of fingers, wrist and elbow. To decrease pain and swelling in the shoulder. To increase shoulder passive ROM. Improve shoulder function. May not lift more than a coffee cup.
Brace: The sling/immobilizer should be worn at all times except for therapy and personal hygiene.
Therapeutic exercises:
Passive shoulder internal and external rotation as directed by the physician
Active forward flexion as tolerated (goal 0º to 90º by 2 weeks)
Active ROM fingers, wrist and elbow with arm at side
Pendulum
Begin active shoulder pinches (spacular retraction) discourage shrugs
Passive ROM in scapular plan below 90º (abduction)
Wand ROM - in supine position flexion to 90º
Avoid shoulder adduction across body and shoulder extension
Watch for signs of RSD
Continue icing program
Isometric forward flexion, extension, adduction, abduction, internal and external rotation (begin at 2 weeks)
Phase 2: 3-6 weeks
Goals: To improve active shoulder ROM, functional mobility, limit pain, and begin light strengthening. May not lift more than 5lbs.
Brace: Change to sling. Discontinue at 6 weeks.
Therapeutic exercises:
Rope and pulley exercise
Continue home program
Continue wand ROM - in supine position
Active ROM forward flexion as tolerated
Active abduction in scapular plane
Gravity eliminated internal/external rotation
No lifting or heavy objects causing axial traction
Begin wall walking for forward flexion
Discourage scapular compensation with forward flexion and abduction
Begin IR stretches (at 4 weeks)
Phase 3: 6 to 10 weeks
Goals: Decrease pain, improve shoulder function, progress active ROM and strength towards normal.
Therapeutic exercises:
Continue overhead pulley system
Continue pendulum
Progress functional use of arm to allow patient normal use of arm in front of the body
Avoid impingement positions
Continue isometrics
Add scapular stabilizer strengthening exercises
Begin ER stretches as tolerated
Phase 4: past 10 weeks
Goals: Attain full functional ROM by 12 weeks.
Therapeutic exercises:
Begin strengthening with rubber tubing/straps at 10 weeks
Continue strengthening (scapular stabilizers, latissimus dorsi, trapezius)
Emphasize rope and pulley system
***Notice***
With proper exercise, strength, motion and function will continue to improve even after one year.
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