Arthroplasty, Shoulder

Ideally rehabilitation for individuals with a shoulder replacement begins before surgery by assessing the individual's medical and social condition in order to determine what they might require postoperatively for a successful outcome. The main goal of the rehabilitation is to restore function by controlling pain, improving the range of motion and strength of the shoulder.

Individuals who undergo total shoulder arthroplasty require a specific rehabilitation process that begins in the hospital and continues in outpatient physical therapy (Boardman). After surgery the shoulder is immobilized for approximately 5 days, during which the individual maintains range of motion of the neck, wrist, and hand by actively moving these joints in all available directions. Occupational therapists can instruct in the use of special equipment for activities of daily living (ADL) and mobility. Modalities such as ice may be used to reduce swelling and pain, and when indicated, heat may be used to promote muscle relaxation (Braddom).

One goal of rehabilitation is the restoration of range of motion. After the period of immobilization, individuals wear a sling, which may be removed for exercise. Therapists begin passive and active assisted exercises after surgery according to the protocol of the surgeon. Special attention must be paid to avoid dislocating the prosthesis and to protect the surrounding soft tissue. Prior to discharge the individual is instructed in a home exercise program, which is continued well after discharge from supervised rehabilitation. When indicated, the individual can start active exercises to achieve optimal range of motion and strength.

Individuals may need to continue both the stretching and strengthening exercises for 1 year after surgery to ensure the restoration of functional strength and range of motion.

Additional information may provide greater insight into the rehabilitation needs of this population (Azar; Dahni).