The Human Shoulder - Post-surgical rehabilitation

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Shoulder arthroplasty is indicated with: joint incongruity, decreased ROM and diminished function. Suregery is also performed for severe arthritis, avascular necrosis, acute fracture or neoplasm. The surgical options for shoulder replacement are total or hemiarthroplasty. Total shoulder arthroplasty (TSA) is indicated with an intact rotator cuff, hemis are indicated with massive cuff tear or complex fractures of the humerus.

Rehab schedule for TSA pts.:

0-3 weeks –

Precautions: no weight bearing, sling at all times, avoid active abduction, extension >0*, external rotation >15*

Treatment: PROM and AROM flexion to 90, abduction to 90, int. rotation to 45*, ext. rotation to 15*; pendulum exercises; isometric strengthening; one handed ADL

3-6 weeks –

Precautions: cont. sling and no weight bearing, may begin active abduction

Treatment: vigorous isometrics; AAROM and AROM exercise; wall walking

6-12 weeks –

Precautions: Lift up to 12 lbs., d/c sling, cont. ROM precautions

Treatment: Vigorous isometrics, progressive isotonics, AAROM and AROM past 90*, 2 handed ADL

More than 12 weeks –

Precautions: d/c ROM precautions

Treatment: active ROM, progressive resistance, strengthening, stretching in flexion, abduction and rotation

Rehabilitation of humeral neck fracture:

In elderly patient: sling, gentle passive ROM and AAROM, pendulum; prevent adhesive capsulitis. As pain reduces isometric strengthening should be included. To preserve shoulder function 90* of abduction and flexion, 45* of internal rotation and 15* of external rotation

In young patient: there’s increased risk for malunion, but less risk of adhesive capsulitis. Immobilization of stable fractures for 6-12 weeks, except for AAROM 2-3 weeks after the fracture.

Useful anatomical nomenclature
The Skeletal and Muscular Anatomy
The Nervous Anatomy
Common causes of shoulder pain and weakness
Shoulder rehabilitation following surgery
Therapies and interventions
Links and references

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