EDU: Shoulder Replacement

[Guest guest]

We all know just how important joint replacements can be to someone who

suffers with severe arthritis but whats also just important is the physio

therapy / rehabilitation that goes along with recouping from such a surgery.

Here is an article that will give you tips on rehabilitation when it comes

to shoulder replacements. The article can be found at Joint

Replacements.com (www.jointreplacements.com) not too mention lots of other

informative information.

Marilyn

Rehabilitation/Physical Therapy:

Physical Therapy Postoperative Out-Patient Shoulder Replacement

Interventions/Treatment

Once your physical therapist has completed the examination, an

intervention/treatment plan will be established. This plan will list the

goals for getting you back to your daily activities. Finally, it will

include a prognosis on how much time and how many visits your therapist

recommends.

You should continue following the precautions taught in the hospital to

protect your shoulder replacement. You may also be instructed in other

activities to protect your shoulder during the first six weeks after the

surgery. Depending on your surgeon, you may need to wear the sling anywhere

from a couple of days post-operatively to several weeks. Some surgeons

recommend using the sling only at night for approximately one month after

surgery. The precautions may include:

Keep sling or immobilizer splint on until instructed otherwise

Minimize or prevent swelling

Elevate the arm

Perform exercises to the other joints of the arm

Avoid any stressful or sudden movements of the arm

Do not lift, push, or pull until instructed otherwise (for example, do not

push yourself up in bed or push up from a chair with the new shoulder arm)

Your therapist may choose from one or more of the following interventions to

facilitate your recuperative process.

Exercises:

Exercises will be performed four to six times daily after you have been

discharged from the hospital for a period of time prescribed by the physical

therapist. Exercises are prescribed by the physical therapist for many

different reasons.

To decrease swelling

To improve your flexibility

To increase your strength

To enhance your endurance

To maintain the motion and strength of your elbow, wrist, and hand

To make the performance of your daily activities easier

Decreasing Swelling

To decrease swelling during the early out-patient period, ice will continue

to be used especially after exercise sessions for up to 3 months

postoperatively.

Improving Flexibility:

To improve the flexibility of your shoulder, the physical therapist may have

you continue the exercises started in the hospital. These may include the

pendulum exercises, the pulley exercises, and the stick exercises. Over the

course of a couple of weeks you will increase your active upward movement

(flexion) of your shoulder to 90 degrees. After approximately five weeks,

you will continue to increase the range of motion in outward (external)

rotation, forward movement (flexion), and backward movement (extension) of

your shoulder. You may also begin a wall climbing exercise to increase your

motion.

Strengthening Exercises:

To increase strength of the muscles around the shoulder, exercises will be

performed in accordance with the type of surgery done. Within one week of

the surgery, you may be able to actively lift the shoulder in a forward

direction. The beginning of strengthening exercises for your new shoulder

will vary in accordance with your surgeon and the surgical procedure. Some

will begin strengthening as early as two weeks after surgery, and some will

wait until four to six weeks after surgery.

Generally the first strengthening exercises will be isometric (static, no

movement contractions) exercises. They will focus on muscles that lift the

arm forward, push the arm backward, raise the arm out to the side and bring

it back to the body, and turn the shoulder inward and outward.

As the recovery process progresses, elastic band or tubing resistance

exercises may be used to strengthen the muscles around the shoulder. Around

three months post-operatively, you may be instructed to begin using light

weights (less than five pounds) for shoulder strengthening. The therapist

will guide you in the weights, which may be used. For example, only

one-pound weights may be used initially, then gradually increasing to

two-pound weights, and so on.

If you have a pool available and are cleared by your surgeon for immersion

in water, aquatic exercises may be incorporated into your overall program.

Exercises should never be " overdone.” If you find your shoulder is swelling

late in the day, it may be a sign you are doing too much too quickly. Pain

should also be avoided. Pain is an indicator something is or was too much. A

small amount of muscle discomfort with increasing exercise may occur, but it

should be " reasonable " discomfort, not pain.

Endurance Exercises:

Endurance exercises will also be progressed so your muscles may function

effectively over longer periods of time. These may include walking,

stationary recumbent bicycle, and any other activity maintaining your

shoulder precautions at this time.

Maintaining Elbow, Wrist, and Hand Motion and Strength:

To maintain motion and strength in your joints surrounding the shoulder, you

will continue the activities started in the hospital. Your therapist may

apply gentle resistance for the muscles around the elbow, wrist, and hand

being sure to avoid stress on the shoulder. You may also use light weights

(less than five pounds) for your shoulder after five weeks post-operatively.

Functional Activities:

Exercises may be included in your program simulating day-to-day activities

like getting in and out of a chair and climbing stairs with your arm. You

will review all of your self-care and home management activities, as well as

all activities related to your job and leisure life. This review is done to

ensure you are able to do your daily activities safely and effectively while

maintaining any appropriate precautions. You will continue to use your arm

as normal as possible while eating, dressing, reading, and doing any other

easy activities with the arm in front of the body. Usually within two to

three weeks after the surgery, patients are functionally using their new

shoulder more than they used their shoulder prior to surgery.

Hot and Cold Therapy:

Ice may be used if there is pain or swelling. Heat may also be used for pain

management and for relaxation. Special care must be taken to make sure your

skin does not overheat and burn.

Home Program:

As your condition continually improves, you will be given advanced exercises

to do at home, in a pool, or in a gym setting. You may be scheduled to

recheck with your physical therapist at regular intervals to make sure you

are doing these exercises routinely and safely. During these rechecks, you

may be given additional exercises to work on over the next few weeks.

Eventually, you will be progressed to a final home program. Once you have

been released to full activity, you may be instructed to follow up with a

few visits over the next few months to make sure you reach your peak level

of performance. Gains in your range of motion and strength may continue for

as long as six to twelve or more months after your replacement surgery.

Minimal stretching of your new shoulder is recommended throughout your

lifetime to maintain your full range of motion.