Reverse Total Shoulder Replacement for Trauma Rehabilitation Protocol
Restrictions:
Immobilisation of the shoulder joint in a broad arm sling continuously for 6 weeks coming out of sling for elbow and wrist exercises.
Shoulder abduction, flexion, and external rotation passively for the first 6 weeks post operatively
Continuous physiotherapy in the community
No heavy strength training or heavy lifting for minimum 12 weeks postoperatively
No heavy manual work recommended long term
Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home
Aim to get early control of shoulder girdle and interscapular muscles
Light pendular and rotation exercises within range of motion limits
Circulation exercises
Do exercises 3 - 6 x per day
Aim for relaxed exercises to avoid tension about the shoulder and neck
At 2 and 8 week follow up
Wound review
Check pain levels
Observe simple ADLs
Range of motion in flexion, abduction and rotation should be measured
Check control of shoulder girdle and interscapular muscles
Phase 1: Post-operative day 1 to discharge
Goals
Swelling and pain management and gentle range of motion
Action
Cryotherapy may begin once sensation has returned to normal
o 20 minutes
Use of sling training
Axillary hygiene
Circulation exercises for the hand
Gentle elbow and wrist exercises
Gentle pendular exercises
Scapular stabilisation exercises and posture training
Independent walking / mobilising training
Direct on limitation of passive motion
o External rotation to neutral
o Flexion to 45 degrees
o Abduction to 45 degrees
Criteria to move to next phase includes
Safe mobility
Pain and swelling well controlled
Able to undertake axillary care and sling management
Phase 2: Discharge to 2 weeks post operatively
Goals
Continue with baseline exercises, swelling management, gentle controlled range of motion
Action
Continue hand and wrist exercises
Continue pendular exercises
Continue gentle passive range of motion
Posture and scapular stabilisation
Criteria to move to next phase includes
Swelling and pain well controlled
Able to perform the basic exercise regime daily with limited pain and swelling
Phase 3: 2 weeks to 8 weeks post operatively
Goals
To achieve comfortable range of motion, control of scapular motion and positioning
Action
Daily active exercises. Continue pendular exercises. Active elbow flexion and extension, hand circulation exercises and scapular muscle activation
Passive range of motion exercises with limits: abduction 60 degrees, flexion 60 degrees and external rotation 0 up to week 6 then up to 90 abduction, 90 degrees flexion and 20 degrees external rotation degrees by the end of 8 weeks. Can institute the use of pulleys.
Relaxation and posture exercises to reduce tension in the neck and shoulder girdle
Criteria to move to the next phase
Near non tender, near pain free for all movements, achieve range of motion as stipulated above (90/90/20). Scapulohumeral rhythm control.
Phase 4: From 8 weeks postoperatively to week 12
Goals
Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature
Action
Passive and active assisted scapular range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion
Scapular mobility exercises
From week 8 begin light isometric shoulder girdle strength including abduction, adduction, flexion and extension.
Criteria to move to the next phase
Minimal swelling and pain associated with exercise.
Achieving good range of motion.
Phase 5: From week 12 onwards
Goals
Return to and normalise activities of daily living including gentle recreational activities.
Action
Increase strength training, progress to concentric and eccentric exercises
Strength for scapulothoracic musculature
Aim for normal active and passive range of motion
Functional training for ADLs