Partial/Total Shoulder Arthroplasty POST-OPERATIVE PHYSICAL THERAPY PROTOCOL
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1 Partial/Ttal Shulder Arthrplasty POST-OPERATIVE PHYSICAL THERAPY PROTOCOL Rehabilitatin Precautins Sling shuld be wrn cntinuusly fr six weeks N internal rtatin (IR) x 12 weeks N crss chest adductin x 12 weeks Frward elevatin in SCAPTION nly N excessive stretching r sudden mvements, particularly in external rtatin (ER) While lying supine, a small pillw r twel rll shuld be placed behind the elbw t avid shulder hyperextensin/anterir capsule stretch/subscapularis stretch Avid shulder active range f mtin (AROM) N lifting f bjects N supprting f bdy weight by hand n invlved side (fr example, pushing up frm a chair) x 12 weeks Keep incisin clean and dry (n saking fr tw weeks) N driving fr six weeks Check with surgen s ffice if psterir instability precautins are indicated n referral r perative reprt Pst-perative 2 weeks Passive frward flexin in supine t tlerance Gentle external rtatin (ER) in scapular plane t available PROM (as dcumented in perative nte), usually arund 30 (attentin: DO NOT prduce undue stress n the anterir jint capsule, particularly with shulder in extensin) Active distal extremity exercise (elbw, wrist, hand) Pendulum exercises Frequent crytherapy fr pain, swelling, and inflammatin management Patient educatin regarding prper psitining and jint prtectin techniques ening Begin scapula musculature ismetrics/sets (primarily retractin) Gals t Prgress t Next Phase 1. Gradually increase passive range f mtin (PROM) f shulder 2. Restre active range f mtin (AROM) f elbw/wrist/hand 3. Reduce pain and inflammatin 4. Reduce muscular inhibitin 5. Independence with activities f daily living (ADLs) with mdificatins, while maintaining the integrity f the replaced jint
2 Week 2 4 Cntinue t prgress PROM as mtin allws Begin assisted flexin, abductin, ER in the scapular plane ening Prgress active distal extremity exercise t strengthening as apprpriate Gals t Prgress t Next Phase 1. Tlerates PROM prgram 2. Achieves at least 90 PROM flexin 3. Achieves at least 90 PROM abductin 4. Achieves at least 45 PROM ER in plane f scapula Week 4-6 Rehabilitatin Precautins Sling shuld nly be used fr sleeping and remved gradually ver the curse f the next 2 weeks, fr perids thrughut the day While lying supine, a small pillw r twel shuld be placed behind the elbw t avid shulder hyperextensin/anterir capsule stretch In the presence f pr shulder mechanics avid repetitive shulder AROM exercises/activity against gravity in standing N heavy lifting f bjects (n heavier than cffee cup) N supprting f bdy weight by hand n invlved side N sudden jerking mtins Cntinue with PROM, active assisted range f mtin (AAROM) Begin active flexin, ER, abductin pain-free ROM AAROM pulleys (flexin and abductin), as lng patient has greater than 90 f PROM Gentle glenhumeral and scapulthracic jint mbilizatins as indicated Cntinue use f crytherapy fr pain and inflammatin Begin shulder submaximal pain-free shulder ismetrics in neutral Scapular strengthening exercises as apprpriate Prgress distal extremity exercises with light resistance as apprpriate Initiate glenhumeral and scapulthracic rhythmic stabilizatin Gals t Prgress t Next Phase 1. Tlerates PROM/AAROM, ismetric prgram 2. Achieves at least 140 PROM flexin 3. Achieves at least 120 PROM abductin 4. Achieves at least 60 PROM ER in plane f scapula 5. Able t actively elevate shulder against gravity with gd mechanics t 100 Week 6-8 Rehabilitatin Precautins N heavy lifting f bjects (n heavier than 6 punds) N sudden lifting r pushing activities N sudden jerking mtins
3 Prgress AROM exercise/activity as apprpriate Advance PROM t stretching as apprpriate Cntinue PROM as needed t maintain ROM Resisted shulder ER in scapular plane Begin light functinal activities Wean frm sling cmpletely Begin prgressive supine active elevatin strengthening (anterir deltid) with light weights (1-3 punds) at variable degrees f inclinatin frm supine t seated/standing Gals 1. Gradual restratin f shulder strength, pwer, and endurance 2. Optimize neurmuscular cntrl 3. Gradual return t functinal activities with invlved upper extremity Week 8-10 Prgress ROM as tlerated. Resisted flexin, abductin, extensin (Therabands/sprt crds) Cntinue prgressing ER strength Gals 1. Tlerates AAROM/AROM/strengthening 2. Achieves at least 140 AROM flexin supine 3. Achieves at least 120 AROM abductin supine 4. Achieves at least 60 AROM ER in plane f scapula supine 5. Able t actively elevate shulder against gravity with gd mechanics t at least 120 Nte: If abve ROM are nt met, then patient is ready t prgress when the patient s ROM is cnsistent with utcmes fr patients with the given underlying pathlgy. Weeks Precautins Avid exercise and functinal activities that put stress n the anterir capsule and surrunding structures (eg, n cmbined ER and abductin abve 80 f abductin) Maintain nnpainful AROM May initiate IR strengthening at the 12 week pstp mark Gradually prgress strengthening prgram t imprve muscular strength, pwer, and endurance Gradual return t mre advanced functinal activities Prgress weight-bearing exercises as apprpriate Typically patient is n a hme exercise prgram by this pint, t be perfrmed 3 t 4 times per week Return t recreatinal hbbies, gardening, sprts, glf, dubles tennis Criteria fr discharge 1. Patient able t maintain nnpainful AROM 2. Maximized functinal use f upper extremity 3. Maximized muscular strength, pwer, and endurance 4. Patient has returned t advanced functinal activities
4 Appendix 1 Simple Shulder Test (Circle yes r n) 1. Is yur shulder cmfrtable with yur arm at rest by yur side? Yes N 2. Des yur shulder allw yu t sleep cmfrtably? Yes N 3. Can yu reach the small f yur back t tuck in yur shirt with yur hand? Yes N 4. Can yu place yur hand behind yur head with the elbw straight ut t the side? Yes N 5. Can yu place a cin n a shelf at the level f yur shulder withut bending yur elbw? Yes N 6. Can yu lift 1 lb (a full pint cntainer) t the level f yur shulder withut bending yur elbw? Yes N 7. Can yu lift 8 lb (a full galln cntainer) t the level f the tp f yur head withut bending yur elbw? Yes N 8. Can yu carry 20 lb (a bag f ptates) at yur side with the affected extremity? Yes N 9. D yu think yu can tss a sftball underhand 10 yards with the affected extremity? Yes N 10. D yu think yu can thrw a sftball verhand 20 yards with the affected extremity? Yes N 11. Can yu wash the back f yur ppsite shulder with the affected extremity? Yes N 12. Wuld yur shulder allw yu t wrk full-time at yur regular jb? Yes N Appendix 2 American Shulder and Elbw Surgens Standardized Assessment Frm- Patient Self Reprt Pain: Hw bad is yur pain tday? (mark alng the line) N Pain Pain is as bad as it can be Functin: Circle the number that indicates yur ability t d the fllwing activities. 0-Unable t d 1- Very difficult t d 2- Smewhat difficult 3- Nt difficult Activity Right Arm Left Arm 1. Put n a cat Sleep n yur painful side Wash back / d up bra in back Manage tileting Cmb hair Reach a high shelf Lift 10 punds abve the shulder Thrw a ball verhand D usual wrk (list) D usual sprt (list)
5 OSU Sprts Medicine 2013
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