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Most surgeries are performed in an outpatient care setting or surgery center. As a patient you will be asked to arrive at the center an hour prior to surgery and can expect to
spend approximately one hour following the case in recovery before being discharged. The more complicated procedures often require an assistant surgeon be present at the time of
the procedure.
After surgery, a pad connected to a cold therapy unit will be placed on the shoulder over the dressings. The unit is designed to decrease pain and swelling by pumping cold water
(approximately forty degrees Fahrenheit) into the pad. Although antibiotics are administered at the time of surgery, they are usually not needed afterwards.
Several small strips of tape will be placed over the wounds at the time of the surgery and are to be left on for seven to ten days. Two or three days after surgery, at the time
of your post-op visit, dressings will be changed. The cold therapy pad can be used as needed. From then on you can remove the pad to take a shower or to change clothes. It is
imperative, however, that when the cold therapy pad is being used there is a thin white paper or a T-shirt between the pad and the skin. A cold therapy unit is usually used for
a period of three to seven days after surgery.
After surgery exercises:
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*Remove the sling to do your exercises. Remember to put it snuggly back on as soon as you are finished. |
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FIGURE 1 -
Forward Elevation: raise the arm out to the front as high as pain permits by supporting the affected elbow. Let gravity help you by gently bending over
at the waist. |
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FIGURE 2 -
External Rotation: Rotate the shoulder by pushing on the affected hand while keeping the elbow at the side. |
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FIGURE 3 -
Pendulum: Do circle pendulum exercises with the arm hanging down and the elbow straight. |
Table Slides (no figure shown): In a seated position, take a paper towel and place it on the table underneath your hand. Gently, using comfort as your guide,
advance your hand in a forward direction with the help of the paper towel. This will help increase your forward flexion. These exercises should be stated three to seven days after
surgery. They should be done twice a day, ten sets each.
Patient can also do scapular squeezes (holding shoulders back) as pain permits
Acromioclavicular (AC) Separation
Only symptomatic grade three and four injuries require surgical reconstruction. This surgery will normally involves a single tendon graft harvested from behind the patient’s knee and
then transplanted to the clavicle. A small incision over the clavicle and another smaller incision behind the patient’s knee are required for this surgery.
The arm will be kept in a sling for six weeks after surgery. Minimal range-of-motion exercises will be done during the first six weeks. Physical therapy will be started at six weeks
after surgery. A return to sports or more aggressive lifting can be expected at four to six months after surgery depending on pain.
Bankart Repair or Capsulorrhaphy
The arm will be kept in a sling for three to four weeks after surgery. Range-of-motion exercises (Figures 1, 2, & 3 on page 2) and the scapular squeezes will be done during the
first four weeks.
Figure 1 – Forward Elevation and Figure 2 – External Rotation: should be done one to three times per day in sets of ten.
Figure 3 – Circle Pendulum: should be done for approximately thirty to sixty seconds, one to three times daily.
Scapular Squeezes: should be done three times per day in sets of ten.
At the end of four weeks physical therapy is started. Full shoulder range of motion is usually achieved within two to four months after surgery.
In the early postoperative period isometric strengthening exercises will be performed. The arm is held gently against the body pushing against the uninvolved hand. This posture is
maintained for three seconds to tense the muscles before relaxing. It is important not to stress the repair while doing the isometric exercises. This technique should be applied to
all six directions of shoulder motion in sets of ten once daily.
Biceps Tenodesis
This procedure is indicated for a patient with severe biceps tendonitis or a rupture in which the biceps tendon is repaired by suturing it down into the front part of the upper arm.
Although the arm is in a sling for two weeks, the sling is removed once a day for gentle straightening and bending of the elbow after one week. The exercises shown in Figures 2 & 3
should be started immediately.
These exercises should be done three to five times per day in sets of ten.
Physical therapy is often started four to six weeks after surgery with stronger elbow flexion exercises following at two months postoperatively.
Capsular Release with Manipulation under Anesthesia
This procedure is indicated for patients with limited range of motion. The arm will be kept in a sling after surgery primarily for comfort. Range-of-motion exercises should be started
the morning after surgery. Physical therapy will be started at one to three days after surgery. Patients may still take six to eight weeks until they have adequate range of motion in
order to return to sports.
Clavicle Fracture
A sling will be used for two to three weeks after this procedure. Minimal range-of-motion exercises will be done until three weeks after surgery. It is rare to have significant shoulder
stiffness following this procedure, for that reason we do not begin aggressive physical therapy until three to six weeks after surgery.br />
A return to sports or more aggressive lifting can be expected at three to four months after surgery when the fracture is healed.
Distal Clavicle Resection (Mumford Procedure)
This procedure is usually performed in conjunction with other surgeries such as rotator cuff repair or decompression. If the resection is performed alone, a sling is used for one to five
days. The three range-of-motion exercises (as directed by our office) should be started the morning after surgery.
The range-of-motion exercises should be done three to five times per day in sets of ten.
Gentle isometric strengthening exercises will also be started on the first day. The arm is held gently against the body pushing against the uninvolved hand. This posture is maintained
for three seconds to tense the muscles before relaxing. This technique should be applied to all six directions of shoulder motion in sets of ten once daily.
A return to sports or more aggressive lifting can be expected at four to six weeks after surgery depending on pain.
Distal Biceps Repair
A long posterior arm splint will be used for four weeks after this. No range-of-motion exercises should be started after surgery. No lifting with the affected arm even when wearing
the splint.
Physical Therapy will begin at four weeks after surgery and gentle range of motion exercise will be started at that time. A return to sports or more aggressive lifting can be expected
at three months after surgery depending on pain.
Rotator Cuff Repair
A sling will be used for four weeks after this procedure depending on the size of the tear. The range-of-motion exercises (Figures 1 & 2 shown on page 2) should be started
the morning after surgery.
These exercises should be done three times per day in sets of ten.
At four weeks, the arm is taken out of the sling and active range of motion is started. Strengthening is started at ten weeks after surgery. Overhead sports can be resumed
four to five months after surgery and golfing can be resumed at approximately three to four months.
Precautions:
-Maintain arm in abduction sling, remove only for exercises
-No shoulder AROM
-Keep incision(s) clean and dry
-No lifting
-No supporting body weight with hands and arms
-No sudden jerking motions
-No excessive behind the back movements
-Avoid upper extremity bike and ergometer
Subacromial Decompression
This procedure involves removing bone spurs and bursitis from the shoulder. The patient will be placed in a sling for approximately one to five days and range-of-motion
exercises are started the morning. These exercises are shown in figures 1, 2, and 3. These exercises should be done two to three times per day in sets of ten.
In the early postoperative period isometric strengthening exercises will be performed. The arm is held gently against the body pushing against the uninvolved hand. This
posture is maintained for three seconds to tense the muscles before relaxing. This technique should be applied to all six directions of shoulder motion in sets of ten
once daily.
SLAP Lesion Repairs
The arm will be in a sling for three to four weeks depending on the severity of the lesion and associated injuries. Two range-of-motion exercises (Figures 1 & 2 on page 2) and
scapular squeezes will be performed during the first four weeks.
Figure 1 – Forward Elevation and Figure 2 – External Rotation: should be done one to three times per day in sets of ten.
Scapular Squeezes: should be done three times per day in sets of ten.
It is important to avoid shoulder extension or any type of biceps stressing during the first two to three months following a repair. Physical therapy will usually be started at three
to four weeks followed by more aggressive strengthening of the biceps and shoulder at approximately two to three months.
These are general guidelines for the more common shoulder surgeries. Often the surgery will involve a combination or variations of the procedures referenced above. Although the
general guidelines usually apply in these scenarios, more specific guidelines will be supplied. Please feel free to ask questions at any time.
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