Total Shoulder Replacement Rehabilitation Guidelines

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PH: 1300 746 853Total Shoulder Replacement Rehabilitation GuidelinesThe following is a detailed outline of the rehabilitation regime for patients who have had aTotal Shoulder Replacement by Dr. Macgroarty.Each case can be very different depending on the goals of the patient, the age of thepatient, the size of the repair, type off repair, etc. We follow these basic guidelines. Anyphysician indicated precautions override these guidelinesYou will have a sling which should be worn day and night for 6 weeks post operatively. Theaim of the sling is to take some of the pressure of the surgical site. You can remove the slingfor the recommended exercises and when sitting quietly - but keep the arm rested on pillowsor arm rest.12-16 hours post opIf local anaesthetic block usedThe block affecting your arm will begin to wear off, so it is advisable to begin takingthe pain killers prescribed for you (eg. Panadeine osteo).Total Shoulder Replacement 1

Day 1 to week 6 (stage 1)What to expectThe pain is often worse at night, especially the first few nights.Don’t forget to use ice and your pain medication.Some patients find it more comfortable to sleep a little more vertical, for instance arecliner.An increase in body temperature is common following an operation.Don’t forget to wear the sling when you are up and about, and to rest your arm on apillow or arm rest when you are sitting quietly.Your wound is cover by a waterproof dressing, you can shower normally.Your first post-operative appointment should be on week 2. We will remove thedressing and review the operation with you.You will not be able to drive until the sling is off and you can lift your armcomfortably shoulder height (8 weeks).No lifting or overhead workStart the following exercisesSome gentle exercises are outlined below. During these exercises, there is to be NOACTIVE MOVEMENT of the operated arm. You are to use your opposite arm to assist withmovements, or allow gravity to move your body into position for exercises such as thependulum. Do each exercise the number of times recommended.All exercises should be done 3 to 5 times a day as your pain allows.Absolutely NO lifting.Avoid too much early active use.1. Bend and straighten elbowUse your opposite arm to assist with themovement of the affected arm initially.REPEAT 10 timesTotal Shoulder Replacement 2

2. Passive Shoulder FlexionPlace hands on top of a bench or chair atwaist height.Step backwards, keeping the arms straight.Bend from the hips and lower your trunkbetween your arms.You should feel a stretch in your shoulder.Hold gently for 10-15 seconds.REPEAT 5 times3. Hand SqueezeThe hand squeeze exercise will improveyour hand strength.Squeeze the fingers of your hand intowards your palm.Hold for 5-10 seconds, then release.You can use a squeeze ball if you have oneavailable, but it is not necessary.REPEAT10 times4. Neck StretchGently stretch your neck from side to side.REPEATas required5. Passive PendulumGently let the affected arm fall away fromyour body as you slowly bend forwardfrom the hips.Aim for a 90 degree angle between yourbody and your arm.Hold this position for 10 seconds.REPEAT5 timesTotal Shoulder Replacement 3

6. Passive External RotationStand with your affected arm up against a doorjamb.Assist your elbow to bend to 90 degrees andkeep your arm resting across the front of yourwaist (just as if it was in the sling).Using a stick or your other hand, push youraffected arm away from your body until youget a stretch.Hold gently at this point for 5-10 seconds.REPEAT 5 times7. PostureWhen you no longer need to wear yoursling, it is important to stretch your backand shoulders to regain your pre surgeryposture.Posture is important especially for a goodfunctioning shoulder.Gently roll your shoulders a few times andsqueeze your shoulder blades together.Gently hold this position for 10 seconds.REPEAT 5 timesTotal Shoulder Replacement 4

Week 6 – 12What to expectYou can stop wearing the sling.You can book your first physiotherapist appointment.Your second post-operative appointment will be around week 8-10No overhead activitiesYou can lift up to 1kg to your waist.You can drive when you are able to lift your arm shoulder high (around week 8)Start the following exercises, after yoursecond post-op appointmentAll exercises should be done 3 times a day1. Flexion stretchSlide both arms up a wall with palm facingtowards you. Move closer to the wall asthe arms slide upwards.5 Repetitions2. Active supported external rotationSit at a table with the elbows bent at 90º,by your side and sup- ported on top of thetable.Keeping your shoulder blades still, slidethe operated side fore- arm so that itswings outwards, away from your body.10 RepetitionsTotal Shoulder Replacement5

Place operated arm behind back and usethe unaffected arm to pull up the one thathas had surgery. 10 Repetitions3. External-internal rotationLay down on your back.Hold stick withgood handin under grip andoperated handin a top grip, elbows bent at 90º.Usingyourgoodhandgentlypushthesticktowards the operated side ofyour body, makingsureyou keep the elbow ofyour bad arm byyour side.10 Repetitions4. Shoulder flexionLie down on your back.Take hold of a stick with both handsplaced wider thanshoulder width apart.Lift your arms above your head until youfeel a stretch, use your good armtomovethe operatedarm.Gently hold at this point for 10 seconds.10 Repetitions5. Shoulder extensionHold the stick using an underhand gripbehind your back.Push the stick backwards away from yourback. 10 Repetitions6. Back towel stretchGrasp towel in both hands.Total Shoulder Replacement6

Week 6 – 3 months phase 2- Isometric strengthening exercises All pushes should be gentle. Don’t push through pain. Follow your physiotherapistrecommendations.10 repetitions of each, 3 times a day1. Isometric flexion3. Isometric adductionWith your forearm in front of you, pull theoperated hand towards your head againstthe good hand which is kept still,providing resistance.Squeeze a pillow into your body with theelbow and arm. Keep the neck relax andthe shoulder blades pinched together.2. Isometric Extension4. Isometric External RotationPush your elbow and arm back into thewall.Keeping your elbow by your side, pressyour forearm so that it swings outwards inthe direction of the wall.Total Shoulder Replacement7

3 months – 6 months (stage 3)What to expectYou can commence light lifting gradually up to 5-10kg.You can start occasional overhead work of less than 15 minutes duration.You can commence Stage 3 exercises.Theraband exercisesPerform theraband exercises in series of ten 3 times (30times), twice a day.1. Theraband rowing2.Theraband resistance adductionHold each end of the theraband. Pull botharms back in a rowing motion. Keep yourelbows bent; pinch shoulder bladestogether as you pull back- wards.Pull the theraband down towards yourbody.Total Shoulder Replacement8

3. Theraband resistance internal andexternal rotationWith elbow at your side, Pull thetheraband inwards towards the frontof your body.Repeat, but pull the theraband awayfrom your body.4. Straight arm liftsLift your operated arm forward up towardsthe ceiling. Keep your elbow straight andthumb facing up. When you are able to dothis, you can add weights.MilestonesReturn to full duties workTotal Shoulder Replacement9

Total Shoulder Replacement 1 PH: 1300 746 853 Total Shoulder Replacement Rehabilitation Guidelines The following is a detailed outline of the rehabilitation regime for patients who have had a Total Shoulder Replacement by Dr. Macgroarty. Each case can be very different depe

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