General Guidelines
Maintain surgical ROM early, don’t push it
This is a constrained implant.
No manual joint mobilization or hands-on stretching
No combined shoulder adduction, IR, & extension; i.e. no motion behind the back
No glenohumeral extension beyond neutral
No weightbearing on operative arm
No lifting anything heavier than a full coffee cup with the operative extremity
These precautions should be followed for the first 12 weeks post-operatively
ROM goals: Forward flexion 90 degrees at 2 weeks, 120 degrees at 3 weeks, 140 degrees at 4 weeks and then full range of motion.
Phase 1 (Weeks 0-3)
Goals:
Reinforce precautions
Control pain and inflammation
Instruct in home exercises for elbow, wrist, and hand – start immediately, maintain full elbow ROM
Begin postural exercises and shoulder activation
Begin Pendulums/Codman exercises at 2 weeks postop
Instruct in ADL’s, e.g. putting on/taking off sling and clothing
Instruct in bed mobility & transfers without weight bearing on operative arm
Precautions:
As per the General Guidelines
Wear the sling at all times except for exercises, dressing, and showering
Patients may shower after 3 days – do not remove steri-strips, No soaking wound until 6 weeks and when incision completely healed with no drainage
Phase 2 (Weeks 4-6)
Goals:
Begin to wean from the sling to wear at night and while out of the house Control pain and inflammation Begin light AAROM
Begin light scapular strengthening Begin sub-maximal pain-free deltoid isometrics in scapular plane
Phase 3 (Weeks 6-12) Goals:
Discontinue sling
Begin AROM against gravity in straight planes, i.e. no combined motions
Progress to light closed-chain exercises
Begin gentle glenohumeral IR and ER sub-maximal pain-free isometrics
Phase 4 (Beyond 12 weeks) Goals:
Can begin AROM with combined motions against gravity
Begin light strengthening but no lifting greater than 6 pounds
Advance to functional activities to enhance function of operative extremity