Shoulder Replacement Rehabilitation

Shoulder replacement requires as individualized rehab programme. Unlike knee and hip replacement surgery, a major tendon needs to be divided to access the shoulder joint. Also the shoulder is the most unstable joint in the body and therefore the rehabilitation plan has to prevent stress on the repaired tendon (subscapularis) and prevent dislocation.

You may come out of your sling to shower and do your exercises after 48 hours unless specified by your surgeon after your surgery.

You should wear your sling at night.

You should use your hand for eating, etc as soon as comfortable.

Expect to go home three days after surgery. You may stay longer if needed

Precautions

You should get up and walk around as much as possible and avoid prolonged periods lying in bed after surgery to prevent clots forming in your legs (DVT's)

For the first 6 weeks

You should wear your sling at night.

You should not drive.

You should not turn your should outwards beyond the neutral position or actively turn your shoulder inwards.

A total shoulder replacement is a lot more unstable than a hemiarthroplasty and therefore requires a more conservative rehabilitation plan

A reverse shoulder replacement, sometimes the bone can be quite soft (osteoporotic) and require a few weeks immobilization before the shoulder is moved to allow the components of the shoulder to knit.

A hemiarthroplasty for arthritis is the most stable replacement and a very active rehabilitation can occur, however preventing stress on the subscapularis tendon repair.

A hemiarthroplasty for fracture to the proximal humerus is the most fragile of shoulder replacements and there may require a very conservative rehabilitation plan.

The rehabilitation plan therefore needs specified for the particular procedure, but can be divided into a

• conservative or limited rehabilitation plan

• standard or regular rehabilitation plan

• reverse shoulder replacement rehabilitation plan

Standard rehabilitation plan

After total shoulder replacement or hemiarthroplasty for osteoarthritis.

After total shoulder replacement or hemiarthroplasty associated with a rotator cuff repair, a fracture or other complicating factors particular care must be exercised and will be specified.

• Shoulder immobilizer to be worn except  when doing physiotherapy

• Active range of motion exercises of the elbow, wrist and  hand should be commenced immediately after surgery.

• Cryo-therapy- Cryo-cuff used regularly from the recovery room

• Pendulum exercises

• Passive range of motion

  • External rotation to the neutral only unless stated otherwise

  • Forward flexion to 90 degrees

• Patients with a total shoulder replacement may do active shoulder flexion in front of the plane of the scapula as pain allows

• At Week 3 begin rope and pulley exercise.

• Include aerobic exercises as soon as possible after surgery

• Provide the patient with instructions for home exercises; instruct patient on home use of sling or immobilizer outside of clothing.

• Patient can generally use arm to eat, read, etc. in front of body (anterior to plane of scapula) when feels comfortable lifts nothing heavier than a coffee cup.

Goal: elevation to 90 degrees, external rotation to the neutral position

After 6 weeks

• gently increase external rotation as tolerated beyond the neutral

• There is no limit to active forward flexion.

• Assisted active internal rotation, restricted by pain

• Wall walking

• Active elbow flexion and extension

• Scapular strengthening exercises

Goal: elevation to 120 degrees, external rotation or 25 degrees.

After 12 weeks

• Continue range of motion exercises and strengthening exercises to full movement as tolerated.

• Continue strengthening of all rotator cuff muscles.

Full recovery from surgery my take 12 up to 18 months.

Conservative rehabilitation plan

• Shoulder immobilizer to be worn except  when doing physiotherapy

• Active range of motion exercises of the elbow, wrist and  hand should be commenced immediately after surgery.

• Cryo-therapy- Cryo-cuff used regularly from the recovery room

• No shoulder movements for the first 3weeks unless specified. The sling is to remain on at all times.

• After the 3weeks unless specified otherwise, return to standard rehabilitation plan.

Reverse total shoulder replacement   rehabilitation plan

shoulder replacements for cuff tear arthropathy have very different bone quality than for osteoarthritis. The bone is usually far more osteoporotic than compared to total shoulder replacement for osteoarthritis. The should also lacks the rotator cuff which provides a significant stabilizing effect on conventional total shoulder replacement.

Pull-out of the components from the bone and dislocations are therefore at significant increased risk than conventional total shoulder replacement for osteoarthritis.

Surprisingly, stiffness after reverse total shoulder replacement  is not usually a problem!

A more conservative rehabilitation is therefore more appropriate.

The features of this rehabilitation are:

• Shoulder immobilizer with the abduction pillow  should be worn full time for the first four weeks

• Active range of motion exercises of the elbow, wrist and  hand should be commenced immediately after surgery.

• Cryo-therapy- Cryo-cuff used regularly from the recovery room

• No shoulder movements for the first 4weeks unless specified. The sling is to remain on at all times.

• After the 4weeks unless specified otherwise, return to standard rehabilitation plan.

Initial Exercises
Pendulum exercises - with the arm down at the side, the patient gently swings the hand forward and backward, then side to side, and then clockwise and counterclockwise This can usually be commenced the day after surgery	Passive  foreword flexion to 90 degrees. This may usually be commenced the day after surgery
	Passive  foreword flexion to 90 degrees (alternative)
After 6 weeks
	External Rotation: initially to the neutral position but can be gradually increased as tolerated after 6 weeks.
Towel Pulls: Start after 6 weeks and increased as tolerated after 6 weeks.	Wall walking: for forward flexion. Start after 6 weeks and increased as tolerated after 6 weeks.

Q and A

How soon can I return to normal activities after surgery?

Try to get up and walk around as much as possible. Use your hand to eat, write or use a keyboard as soon as you feel comfortable unless you were told to remain in a sling and not do exercises. See Conservative rehabilitation plan above.

What can I expect after surgery?

Expect to be in hospital at least 3 days and in a sling for 6 weeks. You may use your hand for eating soon after surgery. Most normal activities around the house can start about 12 weeks after surgery.

Copyright © 2005 [Southern Orthopaedics]