Rehabilitation after Shoulder Arthroplasty.
Last updated Thursday, February 10, 2005
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Figure 3 - Assisted forward flexion in the supine position
Figure 4 - Progressive forward lean
Figure 5 - External rotation while lying on back
Figure 6 - External rotation by holding onto a fixed object
Figure 7 - Internal rotation: Grasping a towel behind the back with both hands
Figure 8 - Cross-body movement
Exercises
Early motion
Early on after your operation the highest priority is maintaining
the gains in motion achieved by your surgery. Because the muscles in
the operated shoulder are expected to be weak after surgery, one has to
depend on other means to maintain the motion during the first critical
weeks. We often use a passive motion machine immediately after surgery
to move the arm gently through an arch of motion even while you are
recovering from your anesthetic.
You will maintain and improve your shoulder reach using a routine which includes three basic maneuvers.
- 1. The Warm-Up
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Bend over, letting the operated arm dangle comfortably in front of you
and move it in gentle circles in a clockwise and counterclockwise
direction with your hand pointing forward and with your hand pointing
back. This is predominantly to loosen up the shoulder and to relax it.
- 2. Assisted Forward Flexion in the Supine Position
- Forward flexion is lifting your stiff arm up as high as it will go.
To stretch your forward flexion, lie flat on your back, relax, and
grasp the wrist of the tight shoulder with your opposite hand. Here's a video of this exercise.
Using the power in your opposite arm, bring the stiff arm up as far as
it is comfortable. Start holding it for 10 seconds and then work up to
where you can hold it for a count of 100. Breathe slowly and deeply
while the arm is moved. Repeat this stretch three times, trying to help
the arm up a little higher each time.
An alternative method of stretching to forward flexion is to use
the "progressive forward lean." Here you sit beside a table, shelf,
armchair back or other fixed object with your arm in a comfortable
amount of elevation in Forward flexion. Then, by leaning forward, allow
the fixed object to apply a gentle, upward-directed force on the arm
for a count of 100. The advantage of this method is that it does not
require the help of the other arm and it can be sustained for a longer
period of time.
- 3. The Pulley
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A pulley is mounted on a door with handles for both hands. Sit in a
chair facing the door. Place one handle in the hand of the operated
shoulder while it is relaxed at your side. Using the unoperated hand to
pull down on the other handle, gently raise the operated shoulder to a
horizontal and then toward a vertical position. Again, this exercise is
performed with total relaxation of the operated arm. When the arm
appears to stop because of stiffness, you should concentrate on
relaxing the operated arm, trying to get even greater degrees of
elevation. When you finally reach the apparent maximum in elevation,
hold it for a count of twenty while optimizing the relaxation.
It is essential that these range-of-motion exercises be performed at
least five times a day. Maintaining the range of motion gained at
surgery is one of the essential ingredients in restoring the function
to your shoulder. There is no one more qualified to do that than you.
Devise a system for registering your progress in these motion
exercises. For example, mark a spot on the bedpost that you can reach
while lying on your back or mark the height on the door that you can
reach with the pulley. Keeping track of your progress on a daily basis
will make sure that you are moving forward and provide you with
well-deserved positive feedback. Your doctor will help you keep track
of your progress.
Other motion exercises are important to your rehabilitation. Your doctor will indicate the exercises you should do.
Movies
External rotation
External rotation is turning the arm out to the side while your
elbow stays close to your body. External rotation is best stretched
while you are lying on your back. Hold a cane, yardstick, broom handle,
or dowel in both hands. Bend both elbows to a right angle. Use steady,
gentle force from your normal arm to rotate the hand of the stiff
shoulder out away from your body. Continue the rotation as far as it
will go comfortably. Work up to holding it there for a count of 100.
Repeat this exercise three times. Here's a video of this exercise.
An alternative method of stretching in external rotation is to hold
onto a fixed object and gently turn your body away while holding your
elbow at the side. The advantage of this method is that it does not
require the help of the other arm and it can be sustained for a longer
period of time.
Movies
Internal rotation
Internal rotation is the motion of reaching up the back. Grasp a
towel behind your back in both hands. To stretch in internal rotation,
gently pull the hand of the stiff shoulder up your back. Work up to
holding the maximum comfortable stretch for a count of 100. Repeat the
exercise three times. Here's a video of this exercise.
An alternative method of stretching in internal rotation is to hold
onto a fixed object behind you with your hand as high up your back as
it will easily reach. Then by bending your knees, a gentle stretching
force can be applied and sustained for a count of 100.
Movies
Cross-body movement
Cross body reach is reaching across your chest so that your elbow
approaches your opposite shoulder. To stretch cross the body, grasp the
elbow of the stiff shoulder in your opposite hand and pull it toward
the opposite shoulder. Work up to holding the maximum comfortable
stretch for 100 seconds. Repeat the exercise three times. Here's a video of this exercise.
Movies
Water exercises
Water exercises are often very well tolerated by the shoulder after
arthroplasty. Gentle movements of the arm in shoulder-deep water,
progressing slowly to swimming the breast stroke and then the crawl are
very helpful in restoring strength, coordination, and endurance to the
shoulder.
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