Wednesday, April 20, 2011

Shoulder arthroplasty for arthritis: rehabilitation: early strengthening

Post surgical rehabilitation is essential to achieving a good result from a total shoulder or a ream and run procedure for shoulder arthritis.

The muscles of an arthritic shoulder are often weak after years of disuse. Shoulder joint replacement does not improve the strength of the muscles, but it does provide smooth joint surfaces that allow for progressive muscle rehabilitation. However, strengthening cannot be started until an excellent and comfortable assisted range of motion is in place.

Once at least 150 degrees of assisted flexion is comfortably achieved

and provided the shoulder does not become painful when doing them, gentle progressive strengthening exercises are often started at week 6 after a total shoulder or a ream and run procedure for shoulder arthritis. These Phase II exercises include the progressive tilting supine press series shown below. The shoulder should be able to perform each exercise comfortably 20 times before advancing to the next step.
In step A, the two hands are held together grasping a washcloth. The hands are pressed upwards as in a bench press action. In step B, one hand presses a light weight (one pound) upwards while lying flat. In step C, the light weight is pressed upwards while lying in a slightly elevated position. The angle of elevation is progressively increased as long as 20 repetitions can be performed at one elevation before increasing it. In step D the light weight is elevated in a standing position.

When step B is achieved, the shoulder blade is elevated at the top of the press as shown below (the press plus).

This helps strengthen the muscles supporting the shoulder blade as does the shoulder shrug shown below.
The final Phase II exercise is external rotation isometrics where the elbow is flexed to a right angle and held at the side while the wrist is pressed against a stable object.

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