![]() Some surgeons choose to manage their patient’s rehabilitation without a separate therapist, but still recognize the importance of carefully instructing and monitoring their patient’s recovery.Īctivities of daily living can generally be resumed while avoiding certain stresses on the shoulder. Postoperative physiotherapy must be carefully supervised. The ultimate goal is to regain strength and full function. The stretching and strengthening phases follow. The full exercise program progresses to protected active and then self-assisted exercises. Poor purchase of screws in osteoporotic bone, concern about soft-tissue healing (eg tendons or ligaments) or other special conditions (eg percutaneous cannulated screw fixation without tension-absorbing sutures) may enforce delay in beginning passive motion, often performed by a physiotherapist. The program of rehabilitation has to be adjusted to the ability and expectations of the patient and the quality and stability of the repair. Early passive motion according to pain tolerance can usually be started after the first postoperative day - even following major reconstruction or prosthetic replacement. The shoulder is perhaps the most challenging joint to rehabilitate both postoperatively and after conservative treatment. Isometric exercises may help maintain strength during the first 6 weeks. Resistance exercises can generally begin at 6 weeks. ![]() Typically, immobilization is recommended for 2-3 weeks, followed by gentle range of motion exercises. ![]() The three phases of nonoperative treatment are thusĭuration of Immobilization should be as short as possible, and as long as necessary. In fractures of the greater tuberosity and/or the surgical neck, the fracture may rest in better reduction if the arm is immobilized in abduction with a cushion.Once these goals have been achieved, rehabilitative exercises can begin to restore range of motion, followed by strength, and function. ![]() The intrinsic stability provided by the periosteum may guide the type of immobilization. Nonoperative treatment should provide mechanical support until the patient is sufficiently comfortable to begin shoulder use, and the fracture is sufficiently consolidated that displacement is unlikely. ![]()
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