Physical Therapy Program for Shoulder Arthroplasty 2024 PDF

Physical Therapy program for Shoulder arthroplasty By prof DR. SAHAR ABDALBARY External Fixation Arthroplasty ▪ Arthroplasty is a surgical procedure that involves the reconstruction or replacement of a damaged or diseased joint. The term "arthroplasty" is derived from t...

Physical Therapy program for Shoulder arthroplasty By prof DR. SAHAR ABDALBARY External Fixation Arthroplasty ▪ Arthroplasty is a surgical procedure that involves the reconstruction or replacement of a damaged or diseased joint. The term "arthroplasty" is derived from the Greek words "arthro," which means joint, and "plastikos," which means to shape or mold. Causes of Arthroplasty Osteoarthritis: This is the most common reason for shoulder arthroplasty. It occurs when the protective cartilage on the ends of bones wears down over time, leading to pain, stiffness, and reduced range of motion. Rheumatoid Arthritis: An autoimmune disease that causes chronic inflammation of the joints, including the shoulder. Over time, this inflammation can lead to joint damage and the need for arthroplasty. Post-Traumatic Arthritis: This can occur after a severe shoulder injury, such as a fracture or dislocation, which damages the joint surface. Over time, this can lead to arthritis. Avascular Necrosis: This is a condition where the blood supply to the head of the humerus (the bone of the upper arm) is disrupted, leading to the death of bone tissue. This can result from trauma, long-term steroid use, or other factors. Rotator Cuff Tear Arthropathy: This is a condition where a massive and irreparable tear of the rotator cuff muscles leads to pain, weakness, and a progressive loss of shoulder function. This can eventually lead to arthritis. Failed Previous Shoulder Surgery: In some cases, prior surgical procedures on the shoulder may not have been successful in resolving the underlying issue, necessitating arthroplasty. Severe Fractures: Some severe fractures of the shoulder may lead to long- term damage to the joint surface, requiring arthroplasty for functional recovery. Aseptic Necrosis: Similar to avascular necrosis, aseptic necrosis is the death of bone tissue due to causes other than infection. It can be caused by factors such as excessive alcohol consumption, certain medications, or systemic diseases. Severe Glenohumeral Instability: Chronic instability of the shoulder joint, often due to repeated dislocations, can lead to significant wear and tear on the joint surfaces, necessitating arthroplasty. ▪  Goal of Arthroplasty 1- To restore 2- acceptance comfort motion of prosthesis and function and implant that lost. longevity. Types of Shoulder Arthroplasty Total Shoulder Arthroplasty (TSA): In this procedure, both the humeral head (the ball) and the glenoid (the socket) are replaced with artificial components. This is the most common type of shoulder replacement. Hemiarthroplasty: In this procedure, only the humeral head is replaced with a prosthetic component. This is typically done when the glenoid is in good condition and doesn't require replacement. ▪ Reverse Total Shoulder Arthroplasty (rTSA): This procedure is used in cases where the rotator cuff muscles are severely damaged or nonfunctional. In a reverse shoulder replacement, the positions of the ball and socket are switched. The ball is attached to the glenoid and the socket is attached to the humeral component. This allows other muscles around the shoulder to compensate for the loss of function in the rotator cuff. Total Shoulder Arthroplasty ▪ ▪ Revision Shoulder Arthroplasty: This procedure is performed if a previous shoulder replacement has failed or is causing problems. It involves removing and replacing the original components. ▪  1-Reduce Pain and Swelling: The goals of physical Modalities like ice, heat, ultrasound, therapy after or electrical stimulation may be used to manage pain and swelling. shoulder arthroplasty 2-Restore Range of Motion typically (ROM): include Passive and active-assisted range of motion exercises help regain movement in the shoulder joint. ▪ Phase 1: Weeks 0 - 6 Restriction ▪ Shoulder motion ▪ Week 1 ▪ -120 degrees of forward flexion ▪ -20 degrees of external rotation with the arm at the side ▪ -75 degrees of abduction with 0 degrees of rotation ▪ ▪ ▪ ▪ ▪ Immobilization Sling ▪ After 7-10 days, sling used for comfort only. Pain Control ▪ Reduction of pain and discomfort is essential for recovery ▪ Medications ▪ Narcotics-for 7-10 days following surgery. ▪ NSAIDs-for patients with persistent discomfort following surgery. ▪ Therapeutic modalities ▪ Ice, ultrasound, HVGS. ▪ Moist heat before therapy, ice at end of session. Motion of shoulder ▪ ▪ ▪ ▪ ▪ ▪ ▪  Shoulder flexion. Active- Shoulder extension. assisted motion exercises Internal and external rotation. Progress to active ROM exercises. Active-assisted motion exercises Motion of Elbow Passive-progress to active 0 to 130 degrees of flexion Pronation and supination as tolerated Muscle Strengthening Grip strengthening only Phase 2: Weeks 6-12 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪  PROGRESS TO OPEN-CHAIN STRENGTHENING WITH THERABANDS ▪ ▪ Six color-coded bands are available; each provides ▪ ▪ ▪ Theraband exercises permit concentric and eccentric strengthening of the shoulder muscles and are a form of isotonic exercises (characterized by variable speed and fixed resistance) ▪ External rotation. ▪ Abduction. ▪ Forward flexion. ▪ Progress to light isotonic dumbbell exercises ▪ External rotation ▪ Abduction. ▪ Forward flexion. Scapular stabilizer strengthening ▪ ▪ ▪ ▪ ▪ Phase 3: Months 3-12 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Muscle Strengthening ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪Thank you