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News Letter

Physical Therapy After Shoulder Replacement Surgery Print E-mail

Before the Surgery

Prior to your scheduled shoulder surgery, you may have the opportunity to visit your physical therapist for a preoperative assessment. One purpose of this visit is to get a baseline of information that includes the location and severity of your pain, your functional abilities, your strength and available motion of each shoulder. A second purpose of the preoperative visit is to prepare you for your upcoming surgery. The preoperative visit is also a time for you to begin practicing some of the exercises you'll use just after surgery. Finally, an assessment will be made of any needs you'll have at home once you're released from the hospital. Your therapist will be scheduled to see you on the first day after your surgery to begin your rehabilitation program.

Inpatient Physical Therapy

You will be seen by your inpatient physical or occupational therapist one day after surgery. If your doctor placed you in a CPM (continuous passive motion) device after surgery, your therapist will remove it to evaluate your shoulder and to begin gentle exercises. If your arm is in a sling, it will need to be removed when you do the exercises. The sling will need to be put back on when you get ready to get up. You will be helped out of bed for a short outing to begin helping you gain confidence being up and about. Along with a short walk, you'll have the chance to use the restroom and perhaps sit in a recliner chair for an hour or so. The distance you walk and the length of time you stay up in the chair will increase as your condition improves. Before your therapy visit is over, your shoulder will be placed back in the CPM or sling. Inpatient treatments are usually done two times per day for up to four days after surgery. By that time, you should be safe and ready to go home. You'll be on your way home once you can safely get in and out of bed, walk 75 feet, and do the assigned exercises by yourself.

Outpatient Physical Therapy

On your first outpatient visit, your physical or occupational therapist will want to gather some more information about the history of your condition. You may be given a questionnaire that helps you tell about the day-to-day problems you are having now that you've had surgery. The information you give will help measure the success of your treatment. You may also be asked to rate your pain on a scale of one to ten. This will help your therapist gauge how much pain you have now and how your pain changes once you've had treatment. Your therapist will probably ask some more questions about your condition to begin zeroing in on the location of your pain and to know what will be needed to help relieve it:

  • How is your pain since having surgery?
  • Where do you feel the pain now?
  • What makes the pain better or worse?
  • How do your symptoms affect your daily activities?
  • Do you have pain in your arm or neck?
  • Do you have swelling?
  • Do you have any numbness or tingling?
Physical Therapy Evaluation Once all this information has been gathered, your shoulder will be evaluated.

Posture: Your therapist will begin by checking your overall posture, including your neck and upper back alignment as well as the position of your collarbone and shoulder blade. If there are any problems in alignment, they will be addressed as part of your total rehabilitation program.

Observation: Your incision will be examined to see if it is clean and that healing of the surgical area is underway. Your therapist will also look to see if there is any swelling, bruising, or muscle wasting in or around the shoulder joint.

Range of motion (ROM): Next, your therapist will check the ROM in your shoulder. In these early stages, the movements will be passive, in which only the therapist moves the arm. In general, the movements that will be measured include arm raising (flexion), and the inward and outward movements (internal/external rotation). Your therapist may also want to get an idea of how other joints around the shoulder are moving. Joints that may be examined include the shoulder blade, collarbone, neck and elbow. Your ROM is written down to compare how much improvement you are making with the treatments.

Strength: Your therapist will probably not test the strength of your shoulder muscles in the early weeks of therapy. These tests are generally avoided early on to avoid placing stress on the healing tissues. Once healing is well underway, however, your strength will be measured in the shoulder and surrounding muscles. Weakness in key muscles of the chest, upper back, and arm will be addressed with a progressive strengthening program. Trained muscles will help control your new shoulder joint, which eases pain and keeps the joint healthy for as long as possible.

Manual examination: You may be given a manual examination of the muscles and joints of the shoulder. Your therapist will carefully move your shoulder in different positions to make sure that each joint around the shoulder is moving smoothly. Your therapist will also look at the flexibility of the muscles and tendons around your shoulder.

Palpation: The evaluation usually ends with palpation. Palpation is when your therapist feels the soft tissues around the joint. This is done to check the skin for changes in temperature, areas of soreness, and whether you have swelling. Palpation is also done to find whether there are tender points or spasm in the muscles around the shoulder.

Treatment plan: Once the examination is done, your therapist will put together a treatment plan. The treatment plan lists the types of treatments that will be used for your condition. It gives an indication of how many visits you will need and how long you may need therapy. It also includes the goals that you and your therapist think will be the most helpful for getting your activities done safely and with the least amount of soreness. Finally, it will include a prognosis, which is how your therapist feels the treatment will help you improve.

 

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