Sling
- The sling is for immediate post-operative comfort, especially while the block is still working.
- The patient should aim to wean from the sling over the following 24 – 48 hours
Things that can be done from day 1
- Hand, wrist, cervical spine, thoracic spine and elbow ranges of movement
- Pain relief as prescribed and to allow exercises to be undertaken in an effective manner
- Range of movement exercises
What are the Restrictions?
- There are no restrictions related to movement – exercises can be passive, active assisted or active.
- This is dependent on the patient’s pain and ability to perform exercises.
- They must be shown how to move there shoulder in all planes prior to discharge.
When can strengthening commence?
- Dependent on dynamic control and range of movement, pain level and functional demand
Patient Education and Advice
Patients should be able to return to driving within 6 weeks but this is dependent on their regained range of movement and control. Patients should be given guidance by their consultant and should also seek advice from the DVLA.
Patients should be allowed to return to swimming as comfortable starting with gentle breaststroke.
Once block has worn off regular application of ice packs can also be an effective source of pain relief and swelling.
Educate the patient on post-operative instructions and expected outcomes following surgical procedure (6 weeks range of movement greater than pre op 6 months full range).
Goals of Rehabilitation
- Reduce pain and swelling
- Maintain the range of movement (ROM) achieved Post-surgery
- Ensure functional improvements of the upper limb.
- Prevent compensatory movements
- To progress cuff control through range
- To develop power and endurance of the appropriate muscle groups (patient specific) and relate to functional tasks
Education
- Encourage cervical spine , hand ,wrist and elbow exercises to avoid secondary stiffness
- Scapula mobilisation exercises
- Passive, active assisted and active range of movement in all planes of movement.
- Capsular stretches
- Supported Isometric rotator cuff contractions progressing to cuff facilitation through range.
- Use a closed and open chain exercise program
- Consider functional specific strengthening exercises
