Swimmer's stretch

For certain sports, having a completely full range of flexion is important. We're impressed with our patients' ability to come up with variations on the flexion stretch.
Here's a photo of one of our patients from Hawaii, a triathlete, who has found a novel twist on the flexion stretch. This method has the advantage of allowing him to relax and apply gentle pressure over ten minutes. The picture speaks for itself.

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Shoulder arthroplasty for arthritis: rehabilitation: the traction three

Our patients have taught us that three additional exercises are useful in the recovery from a shoulder arthroplasty after the first six weeks. Each of these involves applying a gentle pull or traction on the joint, thus we've called them the 'traction three'.  Again, it is important to avoid any exercise that causes pain or that does not feel right. Each exercises is done smoothly and gently.

The first is the gravity swing in which a light weight is held in the hand. The shoulder is relaxed while the arm swings gently back and forth and around in smooth circles.

The second is the gentle row, where the legs and back provide the push while the hands hold onto the bar.

The third is the lat pull with a light weight. Allow the weight to pull up on the arms and relax. Then pull smoothly down so that the bar passes in front of the face.

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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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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty,  and rotator cuff surgery.

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Shoulder replacement for arthritis: rehabilitation: maintaining range of motion: the videos

Thanks to the kindness of some of our star patients, we can show you videos of the key exercises that we use after total shoulder replacement arthroplasty or the ream and run procedure for shoulder arthritis.

The first is continuous passive motion. This video shows one of our shoulder arthroplasty patients in the recovery room immediately after his procedure. The CPM machine gently moves his arm through a comfortable arc, even though he is still asleep. This is the first step for preventing unwanted scar tissue formation.

The next three videos show a man one week out from his right shoulder ream and run procedure doing the three basic range of motion exercises:

The forward lean.

Note the slow and smooth motion of the hand gliding forward on the table as he leans forward.

The supine stretch

Note the slow and smooth motion of the operated right shoulder as the left assists it. Note also the nice slow breathing.

The pulley

Note the patient has his back to the door with the pulley securely fixed overhead. Note the slow and smooth upward motion of the operated right shoulder as it is assisted by the left pulling down.

Here are some tips about the art of stretching.

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You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

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Shoulder arthroplasty for arthritis: rehabilitation: care for the subscapularis.

A key to success after shoulder replacement for arthritis is the post operative exercise program. Click on this link: rehabilitation program to see our usual approach, although this may be modified in certain circumstances.

One of the key facts to keep in mind during the first 6 weeks after shoulder joint replacement is that the subscapularis muscle is cut off the front of the humerus early in the surgical operation to gain access to the joint. In the figure below, the subscapularis has been retracted to the right with two sutures.

Near the end of the case, repair sutures are placed through the bone.

Once the humeral implant is in position, the subcapularis is repaired to the previously placed sutures.

Although this repair is usually strong enough for Phase I of the early motion program, advanced healing of the repair is necessary before the shoulder can be stretched in passive external rotation or strengthened in active internal rotation. For this reason the two sets of exercises shown below are AVOIDED. 

EXTERNAL ROTATION STRETCHING  

INTERNAL ROTATION STRENGTHENING

 Our resident Zlomislic demonstrated that the tension is not evenly distributed across the repair sutures and that the superior suture takes the preponderance of the load in the activities shown above - activities that put it at risk of pulling through the tendon.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.

Shoulder exercises

Since one of the primary manifestations of shoulder arthritis is stiffness, our patients have taught us that gentle exercises, starting with gentle stretching, may be of help in improving comfort and function and delaying the progress of the arthritis. Patients have also shown us that exercises should not be continued if doing them worsens the symptoms in any way. Here are a few exercises that have been helpful to patients with shoulder arthritis. Each exercise is best done when the shoulder is relaxed. Ten to twenty repetitions are often effective, trying to get just a bit more motion with each one. Five gentle sessions a day will often keep the shoulder as loose as it can be. Here are some tips about the art of stretching.

We have also posted some videos of these exercises.

For stretching exercises, be sure to hold the stretch for a full two minutes.

I. The supine stretch in flexion. The shoulders are relaxed. The better arm is used to raise the stiffer arm up and toward a position parallel to the floor. 

II. The forward lean. The shoulder is relaxed. The forearm is placed on a table while the person is seated. By leaning forward and sliding the seat back, the shoulder is gently stretched upward.  

III.  The pulley. With a pulley securely fixed above a seat, one arm pulls gently down, lifting the other arm up overhead.

IV. The gravity swing. With a light weight in the and and with the body bent over at a right angle, the arm is allowed to swing gently back and forth, side to side, and around in circles.

V. The lat pull. With minimal weight, the hands hold the bar allowing the weight to pull the arms up. The shoulders relax while the weight pulls them up.

The bar is brought down under the chin for a few seconds and then the shoulders are relaxed again as they are pulled up.

VI. The row (with all apologies to my patients who are real rowers). With the shoulders relaxed, the hands grasp the bar of the rowing machine. 

Using the muscles of the legs and back, the bar is gently and slowly pulled backwards.

Using the muscles of the legs and back, the bar is gently and slowly pulled backwards. 

Again, all exercises are started slowly and gently and progressed slowly. No exercise should be continued if it makes the symptoms worse.

Also thirty to sixty minutes of aerobic exercise a day (stair climber, treadmill, brisk walking, stationary bike, elliptical, water exercises) are most helpful in keeping the shoulder flexible.

These exercises are quite similar to those we use after shoulder joint replacement.

To see some exercise videos click here.

A word of caution about exercises to avoid is shown here.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).