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Rehabilitation of SRA

POST OPERATIVE TREATMENT REGIMES:
PHYSIOTHERAPY MANAGEMENT OF THE COPELAND SHOULDER

Mrs D Middleton, Physiotherapist, Capio Reading Hospital, UK
Presented at International Shoulder Symposium - Leysin, Switzerland - 4-5 March 2005

Management of the shoulder joint following surgery is more challenging than that of any other joint in the body.  The CSRA procedure is performed in cases of severe Osteoarthritis or Rheumatoid Arthritis, where pain and loss of function are the key features.

The aim of surgery and the post operative management therefore is to provide the patient with a pain free and functional joint. 

The hemi-arthroplasty is usually the method of choice.  It is suitable for all age groups and allows for revision with other methods at a later stage should this be necessary.  Although relief of pain is not immediate following the hemi-arthroplasty, the long term outcome is more satisfactory than that of the Total Replacement.

Pre-operatively patients are assessed for level of pain, loss of function, range of movement and strength, using the Constant Score system.  A full explanation of the post-operative programme, including the time scale involved is given.  Short and long term goal setting is important at this stage, particularly with the younger patient where return to work and sports are more likely to be key issues. Patients are encouraged to maintain their range of movement as much as possible leading up to their operation and appropriate gentle stretching exercises are prescribed accordingly.

Early movement is encouraged from the second post-operative day. Exercises include Codman’s pendular exercises and passive flexion and extension in the scapular plane.  These exercises are performed regularly from discharge to commencement of outpatient physiotherapy.  Initially twice weekly outpatient sessions are required but will be reduced according to the patients’ progress.  The physiotherapist’s role is to provide a programme of exercises tailored to the needs of the individual.  It should be progressive, functional, provide motivation and, if appropriate, sports specific.

How well the individual progresses and the eventual outcome will depend not only on the condition of the joint and soft tissues pre-operatively, but also the age and expectations of that individual.  A better outcome is expected with patients whose joint is replaced for primary osteoarthritis.  Although it could be expected that the younger patient would find restoration of function easier to acquire, this is not always the case.  Work and family commitments often take priority over an exercise programme, leading to a slower rate of recovery.

As improvement can continue for 18 months to 2 years it is important that the individual maintains a regular exercise regime to reach his or her maximum potential.  It is also important to note that this summary applies to patients who have an intact rotator cuff. 

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