Rehabilitation after the Ream and Run Shoulder Joint Replacement Arthroplasty

The University of Washington Approach

Severe arthritis of the shoulder is commonly treated with a total shoulder replacement in which the arthritic humeral head is replaced with a metal implant and the arthritic glenoid socket is resurfaced with a polyethylene component.

Total shoulder replacement is a reliable and effective surgery that provides significantly improved comfort and function for most patients. The rehabilitation is usually straightforward; most patients are well on their way to recovery by 12 weeks after surgery.

The ream and run procedure is a shoulder joint replacement in which the arthritic humeral head is replaced with a metal implant while the arthritic glenoid socket is reamed to a smooth concavity instead of resurfacing it with a polyethylene glenoid component.

This surgery avoids the limitations and potential risk of loosening associated with the polyethyene glenoid socket replacement used in a total shoulder replacement. This procedure is a consideration for patients who desire high levels of shoulder activity after surgery and who are willing to make an extraordinary commitment to the rehabilitation program that can take longer and can be more difficult than that for a conventional total shoulder replacement.

With the ream and run, a specific rehabilitation procedure is necessary to achieve the result desired by the patient and the surgeon. It is essential that the patient adhere to the details of the rehabilitation program and remain in close contact with the surgeon until the shoulder has regained the desired level of comfort and function. Depending on the severity of the arthritis and the patient’s individual healing response, this rehabilitation program may not be complete until a year or two after surgery. Below is an outline of a basic rehab program; it may be modified by the surgeon to meet the individual needs of the patient. The program may be carried out by the patient alone or with the assistance of a physical therapist as long as the therapist adheres to these guidelines.

Your first six weeks

(A) What not to do in the first 6 weeks

During the first six weeks certain precautions must be observed to protect the repair of the subscapularis tendon that is incised to open the shoulder and repaired at the end of the surgery

Do not fall.

Do not let the arm hang by your side – keep the hand elevated at waist level or higher.

Do not lift or carry anything heavier than a full cup of coffee

Do not try to lift the arm by itself

Do not use the arm/hand to push off from a chair or bed

Do not use the arm to close or open doors.

Do not use the arm for pushing or pulling

Do not hold a dog on a leash with the arm.

Do not allow the arm to be rotated further out than the handshake position shown by the arrow.

(B) What to do in the first 6 weeks

Let your surgeon know if you have any questions or concerns.

Do your first set of exercises first thing in the morning and repeat the exercises four more times each day.

Make an exercise calendar and make a check each time you perform your exercises.

Place an ice bag on the side of the shoulder after stretching (not directly over the incision).

Squeeze a sponge or soft ball during the day to reduce swelling.

Keep fit using safe aerobic exercises such as walking, stationary biking, or stair climbing.

Work for the excellent range of forward flexion shown here

The best exercises for achieving excellent forward flexion are the supine stretch, using the opposite hand to assist the arm that had surgery.

and the table slide, in which you lean forward while sliding the arm forward on a smooth table surface.

The keys to these exercises are (1) moving slowly while relaxing the surgical arm during the stretch, (2) holding the stretch for at least 30 seconds, and (3) trying to gain a bit more motion each time. Ideally these exercises are performed five times per day with 5 repetitions each time.

To closely track the recovery of forward flexion, provide your surgeon with frequent updates and emailed photographs of your range of motion in the supine position taken as shown here

Your second six weeks

(A) What not to do in the second 6 weeks

Do not fall

Do not perform any sudden, jerky or heavy activities

Do not be impatient

Do not try strengthening exercises other than those specified here

Do not stretch in external rotation or attempt to strengthen internal rotation.

(B) What to do in the second 6 weeks

Contine to perform the stretching exercises started in the first six weeks at least two to three times a day. Next, start the supine press series, beginning with pressing two hands together toward the ceiling (A and B) and then progressing to a one hand press (C) and then increasing the angle of the body (D and E) always pressing up toward the ceiling and always using an amount of resistance that allows for 20 comfortable repetitions. Any discomfort from the exercises should subside within 20 minutes of stopping the exercise.

Start external rotator strengthening using isometric and band exercises

Unless the surgeon advises otherwise, start these exercises to stretch the back of the shoulder: the sleeper stretch, the cross body stretch and towel up the back

After the first three months,

Continue to perform the stretching exercises often enough each day as necessary to maintain an excellent range of motion.

Add high repetition press ups and shoulder shrugs with light weights

Smoothly and progressively return to high repetition, low load activities (such as lat pull downs and rowing), making sure that the range of motion is maintained and that the shoulder remains comfortable. Gradually return to your normal activities.