Phase I: 0-4 weeks after surgery
Objectives.
1.Promote soft tissue repair.
2.To maintain the integrity of the artificial joint.
3.Progressively increase the passive mobility of the shoulder joint and promote the active mobility of the elbow, wrist and hand.
4.To stop pain and suppress inflammatory reaction.
5.Prevent muscle wasting.
6.Independently perform daily life (different than before surgery, after all, it is after surgery), while keeping the artificial joint intact.
Precautions
1.The shoulder and elbow band must be comfortably suspended for 3 weeks.
2.The shoulder and elbow band must be worn during sleep for 4 weeks, and activity training after regular removal. Use it all day during the day.
3.Pillow should be padded behind the elbow when lying down to avoid hyperextension of the shoulder joint and tension of the anterolateral joint capsule and subscapularis muscle.
4.Avoid active activities of the shoulder joint.
5.Prohibit lifting objects.
6.Prohibit excessive internal rotation to the back of the body.
7.Prohibit excessive tension or sudden activities (especially external rotation).
8.Prohibit supporting the body with the affected limb.
9.Keep the wound dry (no soap for 2 weeks).
10.Prohibit driving for 3 weeks.
Indicators for entering the next stage
1.Be able to tolerate passive range of motion rehabilitation.
2.At least passive range of motion up to 90 degrees of flexion.
3.At least 90 degrees of passive range of motion in abduction.
4.At least 45 degrees of passive range of motion in external rotation (scapular plane).
5.Passive range of motion of at least 70 degrees of internal rotation (scapular plane).
6.Ability to move all shoulder and upper back muscles in equal length.
First day after surgery
1.Lie flat position with passive flexion until tolerated.
2.External rotation to the usual attainable passive range of motion DD generally 30 degrees.
3.Internal rotation to the chest.
4.Active movement of distal limbs (elbow, wrist, hand).
5.Pendulum movement.
6.Ice packs: stop pain, reduce swelling, and suppress inflammation.
7.Educate the patient in the correct position, and avoid joint damage.
The second day after surgery DDD day 10
1.Continue the above exercises.
2.Assisted flexion and abduction (scapular plane).
3.Assist in external rotation.
4.Start as large painless isometric contraction of the shoulder muscles in neutral position.
5.Start isometric contraction of the scapular muscles.
6.Start active-assisted elbow movement.
7.Pulley movements (flexion and abduction) to 90 degrees if possible.
8.Continue with the necessary icing for pain relief and suppression of inflammation.
10-20 days
1.Continue the above exercises.
2.Continue to move within the passive range of motion allowed.
3.Progressively carry out active activities without pain.
4.Progressively perform appropriate strength exercises for the distal limb.
5.Restore the range of motion of the elbow joint.