Welcome to the Welsh shoulder and elbow clinic
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Total shoulder replacement or hemiarthroplasty or resurfacing with tuberosities intact Subscapularis is released and reattached therefore it is important to protect this repair by avoiding external rotation and resisted internal rotation in the early stages of healing. Stiffness must be prevented by early mobilisation that respects the limitations required to protect the subscapularis repair. Atrophy of the muscles is likely in patients who have experienced prolonged pain and disuse prior to surgery and rehab is therefore likely to be slow.
Pre-op Teach elbow,radioulnar, wrist and hand maintenance exercises. Teach pendular exercises Explain post op protocol
Day 1 Polysling and body belt to maintain shoulder in adduction and internal rotation Elbow, radioulnar, wrist and hand maintenance exercises Pendular exercises Passive flexion and passive abduction in internal rotation Progress to active assisted exercises over first week to ten days as pain allows Avoid external rotation beyond neutral
Isometric exercises avoiding internal rotation Continue active assisted exercises
Start to wean from sling and encourage gentle ADL Active movements except for internal rotation Start stretching avoiding external rotation beyond neutral
Start active internal rotation Regain active range of external rotation Resisted deltoid and external rotators Continue stretching to end of range
Unrestricted arm use
Written by Clare Connor MCSP and Claire Kellaway Review date: October 2003 |
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