While your physical therapist may use various treatments as part of your total shoulder rehab, exercise should be one of the main components. So what are good PT exercises that may be done after total shoulder replacement?
Indications
Total shoulder replacement surgery is done to treat severe shoulder arthritis. This occurs when the cartilage of the ball and socket joint wears away. This leads to pain, limited motion, and difficulty performing basic functional tasks with your shoulder and arm.
During shoulder replacement surgery, your surgeon will cut out the degenerated parts of the joint on the “ball and the socket” of your shoulder joint. Then, the “ball” will be replaced by a metal part. A small plastic piece is used to replace the socket, allowing for smooth articulation between them.
Types of Shoulder Replacement
There are two types of total shoulder replacement surgery that you may have: total shoulder replacement or reverse total shoulder replacement. Total shoulder replacement surgery involves cutting out the shoulder ball and socket and replacing them with metal and plastic parts.
The reverse total shoulder replacement is a bit different. During this surgery, your healthcare provider will cut away the ball and socket, and flip-flop them—the metal prosthesis with the ball will be attached to your shoulder blade and the socket will be attached to your upper arm.
The total shoulder replacement is usually done on patients with intact rotator cuff muscles.
Hence, the exercises and rehabilitation after each type of surgery may differ. This means that rotator cuff strengthening exercises may be done only with the total shoulder. Rotator cuff strengthening exercises are avoided with a reverse total shoulder replacement.
Getting Started
When first starting exercises for your total shoulder replacement, be sure to check in with your healthcare provider and physical therapist to ensure that exercise is safe for you to do and that you are doing the correct exercises for your condition.
Physical therapy exercises for total shoulder replacement progress from a gentle range of motion to more active strengthening. Finally, functional training exercises are performed.
If any exercise causes lasting pain in your shoulder or arm, stop it and see your healthcare provider.
Doing shoulder pendulums is easy, but make sure you have your surgeon’s and PT’s OK before performing these at home.
Remove your shoulder from the sling if you are wearing one. Bend forward slightly at your waist, and place your non-operated hand on a flat surface like a table. Allow your operated shoulder to hang down towards the floor. Slowly and rhythmically rock your body so your shoulder moves in a small circle. Keep the circle small—only about 1 foot in diameter is all that is needed. Allow your shoulder to move in a circle for 10 repetitions in a clockwise direction, and then change directions and move your shoulder in a counterclockwise direction.
You can perform pendulums three times each day for about 10 repetitions.
Lie on your back on your bed or another firm surface. Hold the cane in both hands at your waist. Raise the cane up in the air overhead. Use your strong arm to guide your surgical arm up overhead. Slowly return to the starting position. Repeat 10 repetitions.
Don’t be surprised if you cannot get your total shoulder arm fully up overhead. You may only be able to get your arm up a little bit. You should be able to get overhead within a few weeks. It is important not to force your shoulder in any direction.
You can also use a cane to improve the way your shoulder moves out to the side of your body, a direction called abduction. To do this:
Stand with your cane or stick in your hands at your waist. Use your non-operated arm to push your total shoulder replacement arm out to the side. Move your arm as far as possible out to the side, and then slowly return to the starting position. Repeat 10 times.
Shoulder range of motion can also be used with a pulley system attached to the top of your door.
The simplest way to do hand grip exercises is with a towel. Simply roll up a hand towel, and squeeze it in your hand. Hold for a few seconds, and then relax. Repeat this for 10 to 15 repetitions.
Your physical therapist may also prescribe hand grip exercises with putty. You can obtain putty from your physical therapist, or simply purchase some at a craft store or dollar store. Gently squeeze the putty in your hand and hold for a few seconds. You can also pinch the putty with your fingers and thumb.
The hand grip exercises can be done while your arm is in the sling and may be started within a few days after surgery on your shoulder. Of course, always check with your healthcare provider to be sure it’s safe to start any post-op exercise.
To perform these exercises, obtain a resistance band from your physical therapist. Attach it to a secure item like a doorknob.
Use the band to provide resistance as you move your shoulder into internal rotation and external rotation. For strengthening the external rotators, keep your elbow tucked into your side, and slowly move your forearm out away from your belly button. For internal rotation, move your arm in towards your belly button while keeping your elbow tucked.
You can perform 10 to 15 repetitions of internal and external rotation exercises for your shoulder once a day.
You can also perform deltoid strengthening if you have had a standard total shoulder replacement. To strengthen your deltoid:
Stand with your arm at your side. Lift your arm up in front of you, keeping your palm facing down. Raise your arm until it is parallel with the floor, and then hold for a few seconds. Slowly lower your arm down. Repeat 10 to 15 repetitions.
To strengthen the side of your deltoid:
Stand with your arm at your side. Lift your arm out to the side. Raise your arm until it is parallel to the floor. Lower your arm slowly. Repeat 10 to 15 repetitions.
As you get stronger, you can do things to make the exercise more challenging. First, you can use your resistance band (that you got from PT) and hold that while you raise your arm in front or to the side. Or you can choose to hold a small two or three-pound dumbbell while you lift your arm. (A soup can is a good alternative to a dumbbell as well.)
Your triceps muscle travels down the back of your arm from your shoulder to your elbow. To strengthen this muscle, lie on your back with your arm straight up in the air. Allow your elbow to bend slowly. Then, strengthen your arm up against the force of gravity. Repeat 10 to 15 times.
You can hold a two to three-pound dumbbell while you do this to make it more challenging. (Be sure you have a good grip on the weight; you don’t want to drop it on your head or face.)
Your physical therapist can ensure that you practice the right movements and activities so you can regain as much function as possible after your total shoulder replacement surgery. These movements may include working on repetitive lifting, reaching, or gentle weight-bearing onto your arm.
