Fracture Shoulder Replacement Rehabilitation
Indications:
- Severe fractures of the humeral head and neck, that is not reconstructable.
The main aim of the procedure is to reconstruct the tuberosities and rotator cuff around the prosthesis. The immobilisation is to protect this repair.
This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase.
Pre-op
- ROM Exercises
- Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers.
Day 1 - 3 weeks
- Occupational Therapy
- Mastersling with body belt
- Wrist/hand/finger exercises
- Elbow flex/ext, pro/supination
- Shoulder girdle exercises
- Scapula setting exercises
- Pendular exercises
- Passive ROM in all directions as tolerated
- (Level 1 Exercises)
3-6 weeks:
- Do not force or stretch
- Gentle isometric exercises in neutral as pain allows
- Wean off sling
- Begin active assisted exercises ensuring glenohumeral movement, not scapulothoracic
- (Level 2 Exercises)
Any acute loss of active movement should be referred to the next fracture or shoulder clinic
6 weeks +:
- Begin active assisted exercises
- Progress to full active exercises in all ranges
- Begin rotator cuff strengthening (pain free)
- Closed chain exercise
- Begin stretching the capsule
- Begin proprioceptive exercises
- (Level 3 Exercises)
| Milestones | |
| 4 Weeks | 50% pre op passive ROM |
| 6 Weeks |
Passive ROM equal to pre op level |
| 12 Weeks | Active ROM equal to pre op level |
|
Return to functional activities (guide to commence activity) |
| Return to work |
Sedentary job: as tolerated Manual job: 3 months |
| Driving | 6-8 weeks |
| Swimming |
Breaststroke: 6 weeks Freestyle: 12 weeks |
|
Golf |
3 Months |
| Lifting |
Light lifting can begin at 3 weeks. Avoid lifting heavy items for 3 months. |
| Contact Sport | E.g. Horse riding, football, martial arts, racket sports and rock climbing: 3 months |