Shoulder Instability
 

Rehabilitation after surgery

When will I be able to use my shoulder normally again?

You should expect full recovery to take up to six months.

The first few therapy treatments will focus on controlling the pain and swelling from surgery.

 Range-of-motion exercises begin four weeks after surgery, but therapists are cautious about doing stretches on the front part of the capsule for the first six to eight weeks. The program gradually works into active stretching and strengthening.

Restrict your movement to reaching out to the horizontal only and external rotation to the neutral.

Active therapy starts  four weeks after surgery. You use your own muscle power in active range-of-motion exercises. You may begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues.

At about six weeks you start doing more active strengthening. Exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade.  This helps your shoulder move smoothly during all your activities.

By about the tenth week, you will start more active strengthening. These exercises focus on improving strength and control of the rotator cuff muscles. Strong rotator cuff muscles help hold the ball of the humerus tightly in the glenoid to improve shoulder stability.

Overhand athletes start gradually in their sport activity about three months after surgery. They can usually return to competition by  six to nine months but certainly no sooner.

Some of the exercises you'll do are designed to get your shoulder working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your shoulder. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.

What about my sling?

You should use your sling as much as tolerated. We recommend that you use it outdoors and at night for the first four to six weeks after surgery.  You do not need to wear the brace during the day as long as you support the arm. If letting the arm hang causes you pain, then you should not let it hang down without support. It is perfectly all right to go without the sling for period to let your skin air out, especially in the summer on humid days.

 When using the sling you should wear it over a your clothes so that your skin does not become irritated. After about four to six weeks we recommend that you discontinue the slig completely unless you feel better wearing it when out and about.

What about showering or bathing?

We recommend that you not get the incision wet for 2  days after surgery. Even then we recommend only a shower and that you not soak the incision in the bathtub or in a hot tub fir the first week.

What can I do with my shoulder?

Generally it is all right for you to move your shoulder under your own power to reach your mouth, to eat, to hold a newspaper and to reach out in front of you. Generally there is nothing wrong with using the arm at table height and we recommend that you lift nothing heavier than a coffee cup. Usually lifting the arm in front of you will not damage the tissues repaired as part of the surgery, but you should use caution when reaching out to the side (called external rotation or rotation away from the body). This motion is usually restricted to out in from of you  in the first five to six weeks to let things heal. The therapist will work with you to know what you can and cannot do.

When should I start therapy?

Formal physical therapy should begin after about four weeks after surgery. We recommend that you stretch everyday at least once after this time. Strengthening is important, but the most important goal in the first three months is to get your motion back or to improve your motion. Light strengthening is also important.

When can I drive?

It is not safe to drive your car until you can drive normally. There are several reasons for this. First, you do not want to be in a situation where you need to control the wheel but cannot because of your shoulder. That could lead to a bad problem for you or for someone else. Secondly, the last thing you need is to be in an accident and injure your shoulder or damage the repair. There are no hard and fast rules as to when you should or should not drive, but generally it takes at least 4 weeks after this surgery before patients can drive a power-steered automatic.

What about work?

The answer to this question depends entirely upon what you do for a living. The same is true for activities that you do for fun or exercise. Most students can be back to school after three or four days as long as their pain is controlled. If you do "white collar work" or work which involves paperwork or working at desktop level, then we recommend that you return to work around one  week after surgery. If you do work which requires any lifting at all, then we recommend that you wait longer. Most physicians recommend that you not do any lifting over a few kilos in the first three months. Heavy labourers may take longer to have normal function and ability to lift overhead.

When can I return to my sport ?

Full recovery and return to most pre-injury athletic activities occurs in 3-6 months after shoulder reconstruction, depending on the sport you play. However your shoulder has not fully healed for up to one year after surgery. You should therefore avoid returning, at competitive, to level high risk sports such as football, basketball, snowboarding or racket sports for at least nine months.

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