Physiotherapy can help your recovery process after getting any form of shoulder replacement surgery and aid rehabilitation.

“Visited Switch Penshurst , after having shoulder replacement surgery .Tim was able to show me and walk me thru a series of exercises for my shoulder . Very competent young man . We are working on a plan to get me back to full use of my shoulder , I’m confident that this will happen . Thank you Tim”

Peter

Shoulder replacement surgery rehabilitation

As human beings some of us may potentially face the life challenge of damaging a limb or breaking a bone at some point. There can be situations where your shoulder gets so damaged that it might need shoulder replacement surgery to repair it. We can sometimes hear about this happening to sports people or athletes, but it can happen to everyday people like you and I as well.

Switch Physiotherapy has clinics in Penshurst, Concord and Maroubra with experienced physios who can help with physical therapy after your surgery to ensure your recovery is as smooth as possible.

Why would you need your shoulder replaced?

Your shoulder of course is the joint where your upper arm connects to your body & it is a ball-and-socket joint. The bone in your upper arm, called the humerus, has a round end that fits into the curved structure on the outside of your shoulder blade. Ligaments and tendons hold it all together with the ligaments connecting the bones, while the tendons connect muscles to the bone. A layer of tissue called cartilage keeps the bones apart, so they don’t rub against each other. Together the ball and socket lets you move your arm up and down, back and forward, or in a circle to give you the movement you need. There can be different ways that you may feel pain in your shoulder or arms making it uncomfortable or hard to use; A serious shoulder injury like a broken bone Severe arthritis A torn rotator cuff From an accident in a vehicle or at sport In most cases your local GP will help you manage the pain and may even suggest physiotherapy depending on the situation. Although depending how severe the issue is, it may require shoulder replacement surgery and this is about as common as hip or knee replacements.

What happens during shoulder surgery replacement?

In most cases an orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It is a fairly major surgery which requires a few days hospitilisation and then several weeks of physical therapy afterwards to recover and regain your strength. Shoulder replacement surgeries are normally classified into three groups: Total shoulder replacement: This is the most common type. It replaces the ball at the top of your humerus with a metal ball, which gets attached to the remaining bone. The socket gets covered with a new plastic surface. Partial shoulder replacement: Only the ball gets replaced. Reverse shoulder replacement: Usually, you’d get this if you have a torn rotator cuff. It’s also done when another shoulder replacement surgery didn’t work. The metal ball gets attached to your shoulder bones, and a socket is implanted at the top of your arm.

How do you deal with shoulder replacement surgery when you get home?

It is important to think about your daily routines at home before you have the surgery because for a period it will be difficult to lift or move items. Your arm won’t be able to move very much as your body recovers so you may need assistance using friends, family or a private home care nurse. Simple things like moving some of the furniture around or relocating items to be within easy reach can help. It’s important to consider that it can take three to six months for the shoulder to heal while regaining full strength and range of motion can take up to a year.

What was the cause of Peter’s shoulder replacement surgery

Peter had a relatively uncommon procedure; Reverse Total Shoulder Arthroplasty (or replacement). This is different to a total shoulder replacement (the normal ball and socket joint has it’s surfaces reversed in a reverse total shoulder replacement!). Both procedures are usually performed when there are degenerative changes in the shoulder joint – affecting the joint surfaces and the rotator cuff musculature. In Peter’s case, he had these changes but more importantly, his quality of life was severely affected with long standing pain and decreased function in the shoulder being the main issues, and thus leading to surgery.

Why would you need physio to help with shoulder replacement surgery

Physio is integral both after and even before a shoulder replacement procedure. After a shoulder replacement, you will expect to be in quite a lot of pain and will have significantly reduced function for a period after the surgery. This reduced function and pain can manifest into several negative consequences and can linger for longer than expected. To avoid these consequences and maximise your outcomes, a physio will help guide your rehab safely, ensuring that you can achieve your goals.

How does Switch help rehab for shoulder replacement

At Switch, we look to guide your rehab to allow you to safely achieve your goals. This can start before the surgery or shortly after, by providing quality education, advice and setting expectations and goals that you would like to achieve. After the operation, we assess your current function and provide you with an individualised, detailed treatment plan. Treatment can range from various forms of manual therapy to movement prescription with that aim of allowing you return to the things you love.

Can other things help with shoulder replacement surgery

Luckily, the surgeon will normally provide a protocol to follow after your operation. This can provide you with integral information to utilise throughout your recovery. Other things/tips that may help could be: visiting your physio before the operation to begin ‘prehab’, using ice packs to help with pain, continuing gentle movement of other parts of the body to avoid stiffness, contacting your surgeon/physio if you have any questions or concerns.

Other common questions relating to shoulder replacement surgery.

Everyone’s pain threshold is different so it is hard to put a measure that would be applicable to each individual. For the surgery itself you will be under anesthetic & therefore won’t really even realise what is happening. It is post surgery where you will experience pain and this why it is important to consider a rehabilitation plan to help with this. Is shoulder replacement major surgery? In most cases it is considered major surgery especially if it is a complete replacement. It requires the potential removal of bones in the body.
Normally, it is advised to sleep in a reclined position for up to 6 weeks after shoulder surgery. This may vary depending on the surgeon and/or procedure performed. This is to avoid rolling over onto the affected shoulder. Wearing a sling when sleeping during this initial period is also advised.
Normally, after surgery you will be given some instructions on precautions/limitations (as described below). Some examples of what you may not be able to do (in the short term) include: – picking up children – participating in jobs requiring upper limb use – resistance training at the gym – running – playing sports – e.g. golf
After shoulder surgery, you will be given a protocol which will outline precautions/limitations. These will change depending on the procedure performed. Some immediate precautions may include: – No active motion of the shoulder in specific planes of movement for ~4 weeks – No taking off your sling except while doing therapy – No pushing of the upper extremity – No external rotation past neutral (0 degrees) – during PROM with a therapist – No lifting objects
The length of time you need physical therapy after shoulder replacement surgery will depend on each patient’s circumstances and how extensive the replacement was. At Switch Physiotherapy we create a custom treatment plan that is evidence based to ensure you get the required rehab that gets you moving the way you are meant to. This will vary based on your general health, age & what you need to do with the shoulder ie general house duties vs an elite athlete.
It is not advised, as doing a pull up will place a huge amount of stress on the artificial joint surfaces, leading to an increased risk of a failed replacement. As well as this, after shoulder replacement it is difficult to achieve full ROM of the shoulder which means that being able to do a pull up would be almost impossible anyway.
This will depend on the situation but it could be a few days if it is major complete shoulder replacement surgery. It is important to consider the time you will need for rehab when you get home including physiotherapy so that you can manage your daily living or work requirements.
You can lay flat after shoulder surgery, however, you should try to avoid it where possible- especially when sleeping as this can place the shoulder in a position which may lead to injury.
JAMES BECERRA

JAMES BECERRA

An experienced physiotherapist located in Sydney and the General Manager of the Switch Health Group in Sydney.