Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Monday, October 09, 2006
Figure 24 - Getting the arm to externally rotate while lying down Figure 25 - External rotation for strengthening the rotator cuff RehabilitationPhysical therapy A progressive rehabilitation program after posterior glenoid
osteoplasty is critical for achieving optimal shoulder function. For
the first six weeks, the elbow is not allowed away from the side, but
rotational stretching and strengthening exercises are carried out.
Shoulders may become stiff after surgery, so early protected motion
is often suggested. However, the repair needs to be protected from
re-injury, especially during the healing period. Using the �rotator
cuff on� technique described above enables the patient to begin
strengthening exercises immediately after surgery.
Depending on the nature of the procedure, the surgeon will often
prescribe some gentle motion exercises within a limited range of
movement.
The surgeon often wishes to check the mobility of the shoulder two
or three weeks after surgery, to assure that the shoulder has not
become too stiff.
Rehabilitation options It is often most effective for patients to carry out their own
exercises so that they are done frequently, effectively and
comfortably. Usually, a physical therapist or the surgeon instructs the
patient in the exercise program and advances it at a rate that is
comfortable for the patient.
For the first six weeks after surgery, emphasis is placed on
protected motion. For the second six weeks, emphasis is placed on
strengthening exercises to so that strong muscles will protect the
shoulder as it returns to normal activities.
The patient is asked to carry out exercises to maintain flexibility
by carrying out specific, yet simple exercises beginning immediately
after the surgery (see figure 24).
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The goal is for the shoulder to rotate the arm fully with the elbow
at the side--from full external rotation to full internal rotation. As
these exercises become comfortable, specific strengthening exercises
are added, especially in external rotation (see figure 25).
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At the end of six weeks and after a comfortable rotation and
strength have been achieved, the patient starts using the arm out to
the side and then in increasingly forward positions as specified by the
surgeon.
The strengthening exercises are continued for a year after surgery to optimize the dynamic stability of the shoulder. Can rehabilitation be done at home? In general the exercises are best performed by the patient at home.
Occasional visits to the surgeon or therapist may be useful to check
the progress and to review the program.
Usual response Patients are almost always satisfied with the increases in range of
motion, comfort, and function that they achieve with the exercise
program. If the exercises are uncomfortable, difficult or painful, the
patient should contact the surgeon promptly.Risks This is a safe rehabilitation program with little risk.Duration of rehabilitation The strengthening exercises are continued for a year after surgery to optimize the dynamic stability of the shoulder.Returning to ordinary daily activities In general, patients are able to perform gentle activities of daily
living with the operated arm at the side starting two to three weeks
after surgery. Walking with the arm protected is strongly encouraged.
Driving should wait until the patient can perform the necessary
functions comfortably and confidently. This may take up to one month if
the surgery has been performed on the right shoulder, because of the
increased demands on the right shoulder for shifting gears.
With the consent of their surgeon, patients can often return to
activities such as swimming, golf and tennis at six months after their
surgery.
Stressful activities and activities with the arm in extreme
positions must be avoided until six months after the surgery and then
only if the shoulder is comfortable and strong. Long-term patient limitations Patients should avoid activities that involve major impact (chopping
wood, contact sports, sports with major risk of falls) or heavy loads
(lifting of heavy weights, heavy resistance exercises) until one year
after surgery, and until the shoulder has excellent strength and range
of motion--essentially equivalent to the opposite side. In this way the
risk of re-injury is minimized.Costs The surgeon and therapist should be able to provide the information on
the usual cost of the rehabilitation program. The program is quite
cost-effective, because it is heavily based on home exercises.Surgery for posterior shoulder 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 206-598-7416 to make an appointment.
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