Christina Beutler, Brandi Gau, Paige Heiberger, Julie Smith

Osteoarthritis Rheumatoid Arthritis Arthritis of dislocation Avascularnecrosis Acute fractures Post traumatic arthritis Cuff tear arthroplasty Tumor around the shoulder Pain Activities Sleeping Loss of ROM Loss of external rotation Decreased ability to perform overhead activities Decreased ability to perform ADLs

Severe mental dysfunction Weak rotator cuff Patients whose symptoms are not sufficiently disabling to warrant surgery Loss or paralysis of both rotator cuff and deltoid muscles Active infection A progressive disease of the nervous system that has affected the joint

Humeral head is removed Glenoid is reshaped Plastic components are attached Humerus is hollowed out Metal stem implanted in humerus Metal head attached to stem Rejoining of new components of humerus and glenoid

Short exercise sessions 4 – 5 times per day Low number of repetitions PROM or AAROM exercises within pain free range Keep elbow at waist during ADLs Sling Positioning

Avoid sudden forceful movements of shoulder and reaching behind back Avoid weight bearing and lifting heavy objects Avoid AROM and RROM Avoid excessive stress to anterior capsule and suture line Avoid shoulder hyper extension or horizontal abduction beyond neutral No driving

Patient Education Pain Control PROM Codman’s Pendulum Exercises Arm in sling at rest Active exercises to elbow, wrist, and fingers Passive external rotation

Passive elevation in the plane of the scapula Pulleys 120 degrees of elevation Instruct in ADLs Leave hospital

Wear sling while outdoors Able to bring hand to mouth for eating May use hand for writing Active use as tolerated

Gentle elbow ROM Codman’s Pendulum Exercise Full passive forward elevation and ER and pulleys as tolerated Light isometrics Cold pack Ultrasound TENS for pain Advance to hot packs after sutures removed AVOID: Excessive resistance Extension Scapular substitution

Full ROM as tolerated Overhead training Supine elevation with a stick Pulleys

Begin gravity eliminated elevation, IR, and extension stretches Wall stretches

Discontinue sling Advance use in ADLs Isometric exercises for Rotator Cuff and Deltoids Advance resistive exercises and passive stretching AVOID: Excessive resistance in IR

Add isokinetic as patient progresses Modified sports are allowed

Progressive return to sports Progress stretching and strengthening

Shoulder stiffness Usually a result of incomplete rehabilitation Instability The ball slipping out of the socket Infection Nerve damage Glenoid loosening

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