Rehabilitation after Shoulder Arthroplasty.
Last updated Thursday, February 10, 2005
Figure 1 - Continuous passive motion machine: motor-driven adjustable cam and pulley system Figure 2 - Motivation chart displays progress toward the discharge goals About the rehabilitation program
This is the information which might be shared with patients after a
shoulder arthroplasty. Before it can be applied to a specific clinical
situation, however, it needs to be tailored to the patient, the surgery
and the surgeon.Goal of treatment The goal of shoulder arthroplasty is to restore function to an
impaired shoulder. Good shoulder function requires motion, stability,
strength, and smoothness. During the operation your doctor seeks to
optimize your shoulder's motion and stability by balancing the soft
tissues around your joint and releasing adhesions and contractures.
The smoothness of your joint is improved by the implantation of
highly polished artificial joint surfaces. The stage is now set for you
to continue the improvement in motion and stability and to develop some
strength in your reconstructed shoulder with a simple, but vitally
important series of exercises.
Persistence and progressive improvement The goal is to teach you how to successfully rehabilitate your
shoulder. This requires the early gaining of excellent range of motion
and the slow but progressive addition of strength, coordination, and
endurance. Frequent, gentle exercises have been proven much more
effective than irregular forceful efforts. The goal is a smooth
progression in activities without any episodes of soreness from
overdoing it. Make sure that each stage of exercises can be performed
comfortably and with the required number of repetitions before
advancing to the next stage. If soreness does develop, strengthening
exercises are stopped, but the range of motion exercises must be
continued so that stiffness does not result. Nothing must interfere
with the regular five-times-a-day conduct of the range of motion
program.
Many years of shoulder disability cannot be reversed without
persistent work over time on range of motion, strength, and
coordination. The shoulder requires two years of rehabilitative
exercises to reach maximal function after a shoulder replacement. If
you are willing to commit to such a rehabilitative effort, you will
achieve maximum benefit from your shoulder arthroplasty. If you have
any questions about this program, please be sure to ask your doctor.
Since primary goals of arthroplasty surgery are to provide motion
and smoothness, immediate postoperative passive motion is important.
The immediate postoperative program is essentially the same as that
used after the open release of a frozen shoulder. We use a simple
motor-driven adjustable cam and pulley system which puts the shoulder
through a 90 degree arc of flexion and a 45 degree arc of rotation.
This is used for at least 24 of the first 48 postoperative hours. The
patient is taught to use the opposite arm for assisted elevation and
external rotation. A "motivation" chart is maintained on the wall of
the patient's hospital room displaying progress toward the discharge
goals of 140 degrees of elevation and 40 degrees of rotation. Grip and
external rotation isometrics are started immediately. Unless a rotator
cuff repair has been performed, the patient is encouraged to use the
shoulder as comfort permits for active elevation and activities of
daily living. If rotator cuff repairs or osteotomies have been
performed, active motion and isometric cuff strengthening are delayed
until healing has occurred.
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