Post-Op

Guidelines

Reverse Shoulder Arthroplasty

Description

  • The reverse shoulder prosthesis design alters the center of rotation of the shoulder joint by movig it medially and inferiorly, subsequently increasing the deltoid moment arm and deltoid tension.  This enhances both the torque and line of pull/action of the deltoid.  This enhanced mechanical advantage of the deltoid compensates for a deficient rotator cuff, as the deltoid becomes the primary elevator of the shoulder.

General Considerations

  • It is OK to have mild discomfort with exercises, but if it persists more than one hour, the intensity of the exercises must be decreased
  • If there is an increase in night pain, the program must be altered to decrease the intensity  
  • Maintain good upright shoulder girdle posture at all times and especially during sling use
  • To avoid dislocation, avoid shoulder extension past neutral and shoulder internal rotation combined with abduction for 12 weeks (i.e. avoid shoulder motion behind lower back and hip and activities such as tucking in a shirt or reaching behind for bathroom hygiene)
  • Ultimate post-operative elevation is typically around 120 degrees, and external rotation is around 30 degrees
  • A 10-15 lb weight limit should be followed indefinitely on the operative extremity

Immediately After Surgery

  • The patient should get out of bed and mobilize as much as possible
  • Frequent cryotherapy (5x per day, 20 minutes each time)
  • Motion of the fingers, hand, and elbow are allowed to prevent swelling and stiffness
  • The sling (and attached pillow) is necessary for 4 weeks to protect the joint and allow tissues to heal

0-1 Weeks (Immobilization Phase)

  • For the first week, the sling may be carefully removed for hygiene only
  • Continue frequent cryotherapy
  • Begin PROM as soon as nerve block resolves; no shoulder AROM
  • Active/AAROM of the elbow, wrist, hand, and cervical spine

1-6 Weeks (Range of Motion Phase)

  • Sling is discontinued 4 weeks from date of surgery
  • Continue cryotherapy as needed
  • Begin sub-maximal pain-free deltoid isometrics in scapular plane
  • Progress with PROM (forward flexion in the scapular plane to 120 degrees, external rotation to tolerance)
  • AAROM can begin during this time if patient is tolerating the PROM maneuvers
  • AROM can begin in week 3 
  • Gentle resisted exercise of the elbow, wrist, and hand

6-12 Weeks (Early Strengthening Phase)

  • Progress to AROM as tolerated
  • Light passive stretching at end ranges
  • Begin resisted glenohumeral and scapular exercises with light weights
  • Emphasis should be placed on strengthening the scapular stabilizers
  • Isometrics with arm at side beginning at 10 weeks
  • Graduate strengthening activities as tolerated

3-12 Months (Moderate Strengthening/Return to Activity Phase)

  • Full AROM without restrictions
  • Advance strengthening as tolerated:  isometrics, bands, light weights (1-5 lbs) for 8-12 reps and 2-3 sets per particular exercise
  • Only do strengthening 3 times per week to avoid rotator cuff tendonitis
  • Begin eccentrically resisted motions, plyometrics, and proprioception
  • Add total body conditioning, including strength and endurance training if appropriate
  • Initiate work/sport specific drills or activities
  • Initiate appropriate tennis, golf, or other sports program at 4-5 months
  • Maximum improvement is usually seen around 12 months post-op
  • Return to sport, work, and prior activity level unrestricted based on physician approval and completion of rehabilitation program

Contact Information

Ortho.Boston 

145 Rosemary Street, Suite C

Needham Heights, MA  02494

Phone:  781-429-7700

Fax:  781-429-7701

Billing:  781-881-2189

E-mail:  team@ortho.boston

Hours

Monday - Friday:   8:30am - 5:00pm

Saturday:   By Appointment

Sunday:   Closed

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