!DOCTYPE html>
10. Rehabilitation Following Shoulder Arthroplasty
10.1 Total Shoulder Arthroplasty
10.1.1 Prehabilitation
Often termed “prehabilitation,” a couple of sessions followed by a physiotherapist to go over the postoperative rehabilitation program is very helpful to the patient. Emphasis is placed on understanding the goals of therapy and practicing rehab exercises before patients experience postoperative pain and immobilization. Immediate postoperative issues such as dressing, bathing, and activities of daily living are addressed so that the patient feels comfortable with those activities prior to surgery. This is very important especially for elderly patients who live alone and are concerned about restrictions following surgery. We routinely schedule a prehabilitation appointment with a therapist, even when patients are planning to do therapy at home postoperatively.
In total shoulder arthroplasties, postoperative rehabilitation program gives importance to function regaining of an atomic structure repaired with surgery. While previously rehabilitation programs were initiated at later stages in order to preserve surgery and allow for the soft tissue to recover, the recent trend is to begin rehabilitation program at an early stage in a safely manner [1–3].
Postoperative rehabilitation programs reported in the literature generally begin with passive and mild joint movements and progress through active and total joint movement to later on strengthening and endurance trainings. Overall rehabilitation program generally includes three or four phases [1, 3–5], and even though there is no sharp distinction between these phases and although phases differ from each other through the time elapsed following surgery, patient’s functional conditions are very important in order to determine transition between phases.
10.1.1.1 Phase 1: Postoperative Early Stage
0–4/6 Weeks After Surgical Intervention
Goals:
To preserve surgery.
To allow soft tissue recovery.
To control edema and inflammation.
To preserve normal range of joint movement in the surrounding joints.
To gradually increase passive joint movement of treated shoulder.
Rehabilitation Program:
Ice application in order to keep edema, inflammation, and pain under control [8]
Passive shoulder flexion, abduction, and passive internal rotation exercises
Active movements of distal joints
Active assisted wand exercises starting from week 4
Scapular mobilization
Isometric shoulder flexion, abduction, and extension exercises starting from week 4
Scapular retraction exercises in order to obtain scapular stabilization starting from week 4
10.1.1.2 Phase 2: Early Strengthening Period
4/6–8 Weeks after Surgical Intervention
Goals:
To gain total range of joint motion.
Transition from passive to active assisted and then to active movement.
To control pain, edema, and inflammation, when present.
To correct postural defects.
Rehabilitation Program:
Active shoulder exercises should be started toward all directions.
On patients that cannot perform active exercises, neuromuscular electrical stimulation is recommended.
Isometric internal rotation exercises can be started.
Closed kinetic chain exercises can be commenced by conducting load transfer on wall.
Ice application should be continued especially after rehabilitation sessions.
Postural exercises can be helpful according to patient’s needs.
Gentle stretches can be started in order to increase range of joint motion excluding external rotation.
Core stabilization exercises can be started.
10.1.1.3 Phase 3: Intermediate Strengthening Period
8–12 Weeks After Surgical Intervention
Goals:
Regaining shoulder girdle dynamic stability.
Regaining neuromuscular control.
Gradual shoulder girdle strengthening.
Gradual return to activities of daily living.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
