General Instructions

Do not use your arm to hold or lift anything until further notice.
Biceps strengthening exercises are begun 4-5 weeks after surgery.
Do not externally rotate your arm (move your hand out to the side) more than 30 degrees past neutral (neutral position is standing with your elbows bent atyour side and both hands pointing forward - moving your arm toward your body from this position is internal rotation, away is external rotation).

When not doing these exercises, keep your shoulder in the immobilizer:

Starting the day after surgery:
Remove your sling and squeeze your fingers, move your wrist,straighten and bend your elbow, and turn your palm up and down several times a day. This is very important to avoid stiffness in the wrist and elbow. Do all of these daily.

Starting 1 day after surgery:

Do "pendulum exercises" daily, 3 times a day:
Bend forward at the waist while supporting yourself with your good arm on a table – you should be making a 90degree angle at your waist with your operated arm hanging straight down to the ground.

Pendulums

You can move your shoulder passively by standing up and bending over at the waist, allowing the operated arm to dangle down in a relaxed way

Swing the arm gently in all directions – make a figure-8 with your arm.
Do this for 2-3 minutes, 3 times a day.

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Wound care

Your dressing may show blood stains after surgery. This is expected. If the blood is still wet after the first day, seek advice.
Remove all dressings and cover wounds with a dry dressing after three days.
You may shower after 3 days.
Do not swim or submerge incisions in water for 2 weeks.

Follow-up

You should be seen about 2 weeks after surgery for the

wounds to be checked and the findings discussed

First 2 weeks

You must keep your sling on as much as comfortable at this stage
You will be taught how to remove it for washing, and you may rest your arm out of your sling regularly to avoid sweat rashes.
You will be taught exercises to keep your elbow and wrist from becoming stiff
You will be given exercises to strengthen the rotator cuff whilst in a sling
Do not attempt to use the biceps muscle (to lift anything) for the first 2 weeks

2-6 weeks

You will be seen in the clinic for a wound check before 2 weeks
The skin sutures will be removed and the passive range of movement (PROM) will be assessed.
Start to work on forward flexion (arm out straight in front)

Forward Elevation

Passive motion is also easily done while you are lying on your back. Grasp the arm of your operated shoulder with the opposite hand and slowly help the arm up to a vertical position and then over your head. On lowering it back down you will need to concentrate on keeping the operated shoulder completely relaxed

Continue to wear the sling when not doing exercises

At 4 weeks start to work on lifting the arm out to the side (like a wing) with the palm facing the floor. You must still not lift anything until 6 weeks.

6-12 weeks

You will be seen in the rooms at 6 weeks.
If you are still wearing it, the sling may be removed
Start to work on external rotation (elbow in to the side, hand pointing forward, swing the hand out to the side keeping the elbow in)

External Rotation

A second exercise is performed while you are lying down with both your elbows bent to a right angle. Using a cane or dowel or yardstick, gently push the wrist of the operated shoulder out to the side while keeping your elbow at the side

Aim: Forward flexion 100% preop, Abduction and
external rotation 75% at 12 weeks
Once this has been achieved strength work can be developed.

12+ weeks

You may be seen in the clinic at 12 weeks.
At this stage you may start strength work if you have not already done so
Aim: return to throwing by 6 months

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