Total Shoulder Replacement (Ascend Flex)
Sling for 4/52. Can remove sling at night after 4/52 if comfortable. Remain in sling if has night pain or arm moves a lot in bed at night for 6 weeks.
Day 1 on ward – commence active-assisted elevation, external rotation to neutral, short lever scaption and elevation in neutral. Patient may find ball rolling on lap or table most comfortable. Can commence active external rotation as pain allows. Will normally only achieve LR to neutral in first 2-3 weeks. Exercises may be taught to relative as appropriate. May find squeezing a soft ball makes early shoulder movements more comfortable.
Maintenance elbow, wrist, hand and neck exercises, sling care + washing techniques.
Scapula setting and posture.
N.B. AVOID axial loading for 3/12
3/52. Active ROM can be commenced in all movement planes. Hydrotherapy or use of gentle stretches or soft tissue mobilisations to increase ROM. Aim 90 degrees elevation by 6 weeks.
Commence early static isometric cuff exercises at week two, CARE NOT TO OVERLOAD SUBCSAPULARIS REPAIR WITH FORCED OR LOADED MED ROTATION. Start with ant and post deltoid deltoid activation in sagittal plane before moving to LR and MR Progress light rotator cuff and deltoid activation through range after 6/52 as able. Use free weights – half to one kilo as well as light Thera band. Keep in sagittal plane with rehabilitation or ‘in line of vision’ or in an imaginary rectangle box in front of person – ie) Avoid end range ADB with LR movements or end range HBB until 12 weeks.
Clinic review at 6/52, 6/12 and 1 year.
If all well, full active functional ROM exercises as tolerated. Progress overall functional activation of rotator cuff and deltoid and concentrate on functional rehabilitation.
Aim to regain pre-operative movement by 12 weeks.
Return to work: Sedentary 6 weeks (as pain allows). Modified Physical 3-4 months (as guided by surgeon).
Driving: 6 weeks (as pain and range allows). Patient confirms safety to drive.
Sport: 3-4 months dependent on activity (as guided by surgeon)
Swimming: Gentle with modified stroke 6 weeks onwards.