Surgery for Atraumatic Instability of the Shoulder.
Last updated Friday, January 28, 2005
RehabilitationWhat options exist for rehabilitation after surgery for atraumatic shoulder instability? With the arm in the orthosis, the patient is started on grip
strengthening, elbow range of motion, isometric external rotation, and
isometric abduction shoulder exercises. The brace is usually continued
for one month, although longer periods may be used for individuals who
are extremely lax, and shorter periods may be used for individuals over
25 years of age who may be prone to excessive stiffness.
The patient is then weaned from the orthosis over a period of a
week. During this time the patient is taught to elevate the arm in the
coronal plane only, to continue the cuff and deltoid strengthening, and
to avoid any activities that may challenge the repair. From this point,
range of motion is gained only with active exercises; no passive
stretching is used. Lifting of more than 10 pounds is delayed for six
months. Sports are delayed for at least one year after surgery and are
permitted only if the patient has excellent strength and dynamic
control of the shoulder.
The patient needs to understand in detail the importance of this program.
What is the usual rehabilitation plan for a patient after surgery for atraumatic shoulder instability? These are typical instructions given to a patient after a repair for
atraumatic instability. However, the program will vary with the
surgeon, the patient, and the repair. If you have had such a repair,
only your surgeon can give you instructions on the postoperative
management. Do not do any exercises after surgery except after
consultation with your physician.
The arm may be placed in a brace to assure that it heals properly.
If this brace is not comfortable, be sure to let your doctor know
immediately. For one month after the operation your arm must stay in
the brace. If someone can hold your arm in the correct position for you
during bathing, you may briefly remove it for this purpose. Otherwise,
you should clean yourself twice a day using an alcohol sponge
underneath the straps of the brace. You can put on a shirt if someone
can help you by keeping your arm in the correct position while your arm
is threaded through the sleeve. Otherwise you should wear loose-fitting
clothes over the brace.
Each day you can loosen the forearm straps to put your elbow through a range of motion.
Your doctor may start exercises such as these while you are still in
your brace. First, you need to maintain the strength of your grip by
squeezing a ball, sponge, or putty several hundred times a day. Second,
you should perform 3 minutes of gentle isometric exercises at least
three times a day against some fixed object--pushing your wrist
outward, pushing your hand forward, pushing your elbow outward, and
pushing the elbow back. These exercises are designed to maintain your
muscle tone. The shoulder is not moved during these exercises. The
exercises should be comfortable.
You should return to the office at one month after surgery. If
everything is healing properly, you may begin weaning yourself from the
brace at that time.
In the weaning process you will start moving your shoulder out to
the side, avoiding the positions that used to be symptomatic for you.
You may find it reassuring to sleep in your brace for another week. You
will regain your motion on your own, moving your shoulder under its own
motor power and specifically avoiding any stretching. You need to
continue your previous isometric exercises and can add progressively
the same exercises you did before surgery.
Always avoid "checking" your shoulder to see if it is stable. You
must not lift more than 10 pounds for the first six months after your
surgery.
After four months you can begin gentle, well-controlled, repetitive
activities with your shoulder, such as swimming or using a rowing
machine, provided that these activities are comfortable for you.
You cannot return to contact sports or heavy work for at least one
year after this surgery, and then only if you have excellent strength
and coordinated control of your shoulder.
If you have any questions at any time, please let your doctor know.
Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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