Indications:
- Severe osteo or rheumatoid arthritis where the
predominant feature is pain
- Severe fractures of the proximal humerus
Protocol
|
|
In Patient |
|
Day 1 |
- Mastersling with body belt
or Cryocuff sling fitted
in theatre
- Finger, wrist and elbow movements
|
|
Day 2 |
- Body belt removed
- Axillary hygiene taught
- Handing gripping exercise
- Pendular exercises
- Scapular setting
- Passive flexion in the scapula
plane
- External rotation to neutral only
- Discharge usually at day
2
|
|
|
Out Patient |
|
Day 5-
3 weeks |
- No active internal rotation
(reattached subscapularis muscle is vulnerable)
- Begin passive abduction (maintain
shoulder in IR)
- Passive external rotation to
neutral only
- Active assisted flexion in supine
and progress to sitting position as soon as the patient is able.
- Progress to active when possible
- Begin isometric strengthening of
all muscle groups (except IR)
- Remove sling as able
|
|
3 weeks + |
- Encourage active movement into
all ranges with some gentle self-stretching at the end of range.
- Add isometric IR
- Progress isotonic strengthening
though range
|
|
6 Weeks + |
- Progress strengthening
- Regularly stretch the joint to
the end of its available range
|
Improvement continues for 18 months to 2 years and the
patients should continue exercising until their maximum potential has been
reached
Return to functional activities
Driving
After 4 weeks
Swimming
Breaststroke: 6 weeks
Freestyle: 12
weeks
Golf
3 Months
Lifting Light
lifting can
begin at 3 weeks. Avoid lifting heavy items for 6 months.
Return to work
Sedentary job: 6 weeks
Manual job:
Guided by Surgeon
For more information please contact
therapists@shoulderdoc.co.uk
25/05/2004
|
