Monday, April 18, 2011

Shoulder arthroplasty for arthritis: rehabilitation: maintaining range of motion

Post surgical rehabilitation is essential to obtaining the desired result from a total shoulder joint replacement arthroplasty or a ream and run for arthritis of the shoulder.

Yesterday we emphasized the importance of protecting the repaired subscapularis during the 6 to 12 weeks required for it to regain its secure attachment to the humerus.

During this time, it is also critical to maintain the passive range of motion achieved at surgery in a manner that does not threaten the subscapularis repair. This is usually accomplished by the use of continuous passive motion (CPM) immediately after surgery in which a carefully controlled machine gently moves the operated arm through a range of motion while the patient relaxes. CPM is usually continued during the period of hospitalization while the patient is in bed so that restricting adhesions do not have a chance to form.
On the day of surgery, assisted range of motion exercises are also learned by the patient. This are simple exercises that can be done anywhere with no special equipment.  These include assisted elevation, as shown below
and the forward lean, as shown below
These exercises must be mastered by the patient and a range of 150 degrees of elevation consistently attained by the patient before leaving the medical center. 

We use a chart on the wall of the hospital room to track their forward elevation so the patient can see their progress towards the 150 degree target for hospital discharge.

We usually prescribe visits to a qualified physical therapist to monitor the patient's recovery. It is essential, however, that the patient and the therapist adhere to the details of our post surgical rehabilitation program.

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