Arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability: why, when and how it is done.
Edited By: Suzanne L. Slaney, PA-C, ATC, MMS, Christopher J. Wahl, M.D.
Last updated Tuesday, January 25, 2005
RehabilitationWhat types of physical therapy do patients require after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability? Some early motion is important after shoulder stabilization, but
unrestricted motion can endanger the success of the procedure. For the
first 3 or 4 weeks, the patient is scheduled to see a physical
therapist once or twice per week to monitor the progress of healing and
to reiterate the proper exercises.
After a few weeks, the sling is removed, and a more comprehensive
rehabilitation program is started. During this period, the therapist
works closely with the patient to re-establish a normal range of
motion. The therapist and patient work together, but the patient is
expected to do “homework” on a daily basis so that constant improvement
is achieved. Once a normal range of motion is re-established, shoulder
strengthening is started. It takes about 12 weeks before the shoulder
is completely rehabilitated for the normal activities of daily living,
and about 16 weeks before contact athletics, throwing, and overhead
sports can be re-started. A good therapist can work with the patient on
“sports-specific” training to re-train the muscles and shoulder for
golf, tennis, throwing, and swimming. What options exist for rehabilitation after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability? The results of physical therapy are optimized by a competent therapist, familiar with the procedure and the usual expectations, and a compliant patient,
who is responsible to do home exercises and is motivated to improve.
Most surgeons have a standard “protocol” that they can give to a
physical therapist to let them know how to rehabilitate the shoulder.
It is important for a patient to find a therapist with flexible hours
and in a convenient location because the therapy will become part of a
routine for 3 to 4 months. The surgeon can recommend a therapist or
therapy group with whom he or she is used to working and who is
familiar with the procedure. Therapy is generally done on an outpatient
basis, with 2 or 3 visits per week so that the therapist can check the
progress and review or modify the program as needed to suit the
individual.What is the usual response to rehabilitation after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability? Patients are almost always satisfied with the range of motion,
comfort and function that they achieve as the rehabilitation program
progresses. The sense of “apprehension” or pain with overhead motions
is usually eliminated. Occasionally, persons will have slight decreases
in their overall overhead mobility, as the shoulder has been tightened.
These minimal decreases usually do not affect the ability to perform
overhead activities or prohibit a return to athletics at the same or a
higher level. Figure 9 shows a patient who presented with recurrent
dislocations and subluxations after an initial traumatic shoulder
dislocation. The figures show her range of motion following the repair
of the stabilizing ligaments and rehabilitation of her right shoulder.
Despite her active lifestyle and rigorous occupation, she has not
suffered any further events of shoulder instability.
If the exercises remain or become painful, difficult, or
uncomfortable, the patient should contact the therapist and surgeon
promptly.
Are there risks to rehabilitation after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability? There are very few risks to appropriate postoperative therapy. If the
therapist and surgeon are not in communication about what exactly what
was done and what the short and long term expectations are following
this procedure, the therapist can be too aggressive or alternatively
too timid about the rehabilitation. This can result in failure of the
procedure (re-dislocation or subluxation) or excessive shoulder
stiffness. It is exceedingly uncommon for these problems to occur.How long will rehabilitation after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability need to be continued? Every patient is slightly different. Once the range of motion is
acceptable and the strength has returned, the exercise program can be
cut back to a minimal level. Patients who have special needs, such as
overhead athletes, swimmers, overhead laborers, and throwers may
require sports-specific training with a therapist or athletic trainer.How long after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability will patients be able to return to ordinary daily activities? In general , patients are able to perform gentle activities of daily
living with the operated arm at the side starting 2 or 3 weeks after
surgery. Most persons who work at a desk job can return to work during
this time. The patient is strongly encouraged to continue wearing the
sling at all times for the first 3 to 4 weeks to remind themselves (and
others) that the shoulder is injured and healing, and to limit overhead
activities.
Driving should wait until the patient can perform the necessary
functions comfortably and confidently, and the pain in the shoulder is
at a minimum and pain medications are not required. A good question to
ask a patient is “Would you want you driving if your 4-year old child
was in the car or playing in the street?” In general it may take longer
for a person to drive after the right side has had the procedure
because of the increased demands on the right arm for shifting gears,
etc.
With the consent of their surgeon, a patient may return to
activities such as swimming, golf and tennis between 4 and 6 months
following the procedure. More extreme sports (wrestling, pitching, rock
climbing, etc) should only be undertaken when the shoulder is extremely
comfortable, and the strength is within 90% of the opposite side.
After full recovery and rehabilitation from arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability, what are the limitations on the patient? Patients must avoid impact activities (chopping wood, contact sports,
sports with risk of falls) and heavy lifting (overhead labor, lifting
heavy weights) until after the strength has returned to normal.
Occasionally, the extremes of motion overhead and behind the back or
head may be limited because the shoulder joint has been tightened.
These limitations almost never affect daily activities and usually do
not impact a return to sports at or above the level achieved before the
shoulder became unstable.How can the costs of rehabilitation after arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability be anticipated? The surgeon and therapist should provide the information of the
usual cost of the rehabilitation program. Most insurances will cover
the costs of some or most of the rehabilitation, except perhaps a
“copay” that the patient must pay at each visit. Careful adherence to
the home exercises between visits will usually decrease the overall
number and frequency of visits required.
Surgery for shoulder dislocation, subluxation, and instability at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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