Shoulder Problems

The most common cause of acromioclavicular joint arthritis is wear and tear through over use. For this reason it is most common in people who are aged 50 or older and in athletes who place a lot of stress on the joint.

Bicep Problems

The most common shoulder conditions affecting the biceps are injuries to the cartilage and tendons that attach the biceps muscle to the shoulder bones. These include SLAP lesions, tendonitis, and tendon rupture.

Calcific Tendonitis

Calcific tendonitis is a build-up of calcium deposits within one or more of the four tendons that meet at the top of the shoulder joint. Together these four tendons are known as the rotator cuff.

Frozen Shoulder

Frozen shoulder is a condition where the ball and socket joint of the shoulder appears to "freeze". This causes loss of motion with stiffness in all directions. Typically the shoulder joint is stiff and initially painful.

Shoulder Arthritis

Glenohumeral arthritis is also known as shoulder arthritis. It is a progressive type of arthritis that is normally caused by damage to the cartilage surfaces of the shoulder's glenohumeral (ball and socket) joint.

Shoulder Instability

This is when the ball of your shoulder slips in certain position or completely comes out of joint (dislocates). There are a number of types of instability and it can get worse with time.

Rotator Cuff Injuries

The rotator cuff is the group of four tendons that surround the shoulder joint and control its movement. The tendons can become inflamed, degenerate or tear and can lead to pain and weakness, particularly with sudden movements.

Snapping Scapula

Snapping scapula is a general term applied to a range of disorders that can result in a painful clicking or snapping sensation in the shoulder blade (scapula).

Subacromial Impingement

Subacromial impingement is a condition that causes pain in the shoulder and upper arm. It happens when the tendons of the shoulder joint are strained or injured.

Winging Scapula

Winging scapula is the description for a condition where the shoulder blade protrudes from your back, giving the impression of a wing. In most cases, only one shoulder blade is affected.

Reverse Total Shoulder Replacement

Physiotherapy Protocol for REVERSE Total Shoulder Replacement

Phase 1 - PROTECTED MOBILISATION

Days 1-5 (on ward)

Patient independent on ward with sling and dressing management, ADL with or without assistance of carer or family. Sleep and resting position in scapula flexion.

Commence active assisted elevation in supine with a short lever to 90 ͦ. Ensure resolution of interscalene block before commencing exercises.

Standing shoulder blade shrugs

Gentle pendulum swings into flexion from standing. Gentle sliding hand along lap or table – assisted elevation with weight of arm supported.

Days 6 to 14

Continues with above until first physiotherapy out- patient appointment

Supine active assisted flexion progression with a stick. Progress to standing with a stick assisting

Phase 2 - MOVEMENT CONTROL PHASE

Approx. weeks 2 to 6

Continue with active assisted ROM exercises from phase 1.

Sling for busy environments or outdoors. Sleep with sling until 6 weeks. Slowly wean off sling in day.

Active GHJ to 90 ͦin supine to sitting at incline angles of 10 ͦ. (From short lever to long lever)

Gentle static isometric exercises in neutral 20% effort only. Start sagittal - ant/post deltoid then rotation

Active external rotation to 30 ͦ(supine then standing as able)

Supine external and internal isometrics with a stick at neutral then 30 degrees, 60 degrees.

Scapula movement control and re-education as necessary.

Only progress to next stage if pain is controlled and acceptable movement patterns.

Phase 3 - Functional Rehabilitation

Avoid weight bearing through the upper limb. Avoid sudden lifting and pushing of loads.

Weeks 6 to 12

Elevation in supine with 0.5kilo weight.

Loaded GHJ flexion from supine to sitting just using weight of arm.

Standing external and internal rotation with light resistance as patient ability allows.

Resistance yellow tubing pulldowns in sitting.

Loaded GHJ flexion, controlling range and avoiding hyperextension.- use one kilo weights max.

Weeks 12 to 26

Vary and increase repetitions to improve Rotator cuff activation and endurance.

Please do not push external rotation beyond 30 degrees.

The patient may experience impingement beyond 85 degrees abduction therefore it may be appropriate to rehabilitate in the scaption plane. Please avoid hyper extension and HBB until the patient has movement control and can perform without forward translation of humeral head.

Andrew Cole6 November 2018

Reverse Total Shoulder Replacement

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