Sling
- 3 Weeks
Things that can be done from day 1
- Active assisted supported movements within the safe zone*
- Hand, wrist and elbow active range of movement
*Safe zone Active assisted glenohumeral flexion to 60° , Active assisted abduction to 45° , Active external rotation to 30° respecting pain and movement pattern unless stated as otherwise by the surgeon in the operation notes.
What are the Restrictions?
- Avoid combined IR (hand behind back)
- Patient should avoid lifting anything heavier than 1-2lbs, weight bearing on the
- arm or allowing downward traction on the arm e.g. carrying bags for 6 weeks
When can strengthening commence?
- Dependent on dynamic control and range of movement and pain level
Early Phase 0-3 weeks
Patient Education and Advice
The sling is to be worn preferably in the “gunslinger position” and only removed for axillary hygiene and to perform exercises. It must be worn for bed. Its purpose is for comfort and protection of the arm from vulnerable positions.
Pain relief should be taken on a regular basis to allow for good management of pain and to allow exercises to be undertaken in an effective manner. Regular application of ice packs can also be an effective source of pain relief and for swelling and bruising.
Goals of Rehabilitation
- Protect the repair and optimise tissue healing
- Reduce pain and swelling which may be a cause of muscle inhibition
- Gain and maintain the safe zone of range of movement (ROM)
Exercises
- Maintain hand wrist forearm and elbow ranges of movement
- Reinforce postural correction
- Supported isometrics
- Active assisted flexion, abduction and external rotation mobilisation within the safe zone
- Rotator cuff facilitation exercises within the safe zone
- Scapula mobilisation exercises e.g shoulder shrugs, scapula retractions and protraction
- Encourage use of the hand whilst in the sling for light activities such as writing, feeding
- Reinforce good movement patterns
NOTE: Research demonstrates that patients who engage their hand on the side of the operated shoulder during the immobilisation phase of rehabilitation generally have better outcomes in relation to pain and function.
Mid phase weeks 3-6
Patient to wean from sling.
No combined internal rotation work.
Exercises
- Scapular stability and control work as required
- rotator cuff facilitation exercises
- Proprioceptive work (minimal weightbearing below 90 degrees)
- Correct and modify ergonomics as necessary
- Progress active flexion to 90°
- Progress active abduction to 60°
- Active external rotation to 30°
- Progress to strengthen Biceps and Triceps within available ROM
- Commence light weights
Guidance for exercise progression
- Good pain control
- Progressing range of movement
- Absence of compensatory movements such as hitching , ensure good scapular control
through range - Exercise compliance
Weeks 6-8
Goals
- Gain and maintain the functional range of movement (ROM)
- Prevent compensatory movements such as shoulder hitching which may compromise recovery
- Enhance proprioception
- Optimise recruitment of the dynamic stabilisers
Exercises
- Regain scapula & glenohumeral stability, working for shoulder joint control rather than range
- Optimise proprioception through open & closed chain exercise
- Progress to full ROM of flexion, abduction and external rotation
- Introduce internal rotation (in 90° flexion or 90° abduction)
- Strengthen Deltoid, Biceps & Triceps
- Scapular stability exercises
Weeks 8-12
Goals
- Restore full active range of movement
- Enhance neuromuscular control
- Optimise preparatory and reactive stabilisation
- Restore optimal cuff and scapula control through range and under load
- Optimise function specific power, strength and endurance
- Transference movement pattern correction and cuff/scapula control to
- functional task
Exercises
Week 8-12 for lockdown patients
- Rotator cuff and scapular stability work – open chain and closed chain with kinetic chain
- Sport specific drills as necessary
- Functional work progressions
- Function specific plyo-metrics
- Function specific strengthening and endurance exercises ensuring glenohumeral joint and scapula control are maintained
- Preparatory and reactive stabilisation drills in risk positions
- Function specific kinetic chain strength and endurance
Week 8-12 for Weaver Dunn patients
- AROM through range as symptoms allow
- Continue with rehabilitation as per weeks 6-8
>12 weeks for Weaver Dunn patients as per weeks 8-12 for lockdown patients
