Rehabilitation following shoulder injuries and shoulder surgery is an extremely important modality of therapy.
Shoulder pain and loss of motion, from impingement, tendonitis, rotator cuff tears, both partial and complete, capsulitis, arthritis, shoulder fractures and clavicular fractures, biceps lesions, labral tears and instability of the glenohumeral and acromioclavicular joints can in many cases be successfully managed with exercises, cortisone injections and anti-inflammatory medication. When these modalities fail then surgery may be required.
In addition specialised and supervised physiotherapy after arthroscopic acromioplasty, arthroscopic and open rotator cuff repair, arthroscopic excision of the distal clavicle, arthroscopic capsular releases, arthroscopic debridement, arthroscopic labral repair, arthroscopic stabilisation and open stabilisation, biceps tenotomy and tenodesis, mini open rotator cuff repair, single and double row arthroscopic rotator cuff repair, Pectoralis Major repair,total shoulder replacement, reverse shoulder replacement and hemiarthroplasty of the shoulder are necessary to achieve optimal results.
Physiotherapy for rotator cuff tears and impingement can reduce the inflammatory response and retrain the muscles that are not damaged to take over the function of the damaged muscles. After most types of surgery the arm will rest in a sling for 4 to 6 weeks to allow the tissues to heal and for good scar tissue to form. Capsular stretches and rotator cuff, deltoid and scapular stabilising exercises are recommended once the tissues have started to heal. Rotator cuff tears and impingement can respond well to shoulder rehabilitation without shoulder surgery, providing the tears are not big and function is not significantly compromised. Where shoulder function is compromised surgery is required to repair the rotator cuff tear, and perform an acromioplasty. Surgery to repair the rotator cuff can be performed arthroscopically or in an open manner depending on the tear size and rotator cuff quality. Nowadays most shoulder surgery is perfomed using arthroscopic or keyhole technoques.
Osteoarthritis, rheumatoid arthritis , and traumatic arthritis of the shoulder generally requires surgery when symptoms are severe. After shoulder arthroplasty, whether a total shoulder replacement, reverse shoulder replacement or hemiarthroplasty, physical therapy is required to regain function and range of motion. Although reasonable motion can be regained it is uncommon to regain greater than 70% of motion even with the best outcomes.
Instability of the shoulder is often amenable to non operative management when there is no damage to the labrum, or cartilage, or the bone of the shoulder joint. Sometimes several months of specific exercises are needed to achieve stability. When, however, physiotherapy does not work, or the shoulder has significant damage, either an arthroscopic stabilisation or open stabilisation is required. Arthroscopic surgery is usually successful if there is not significant bony damage, otherwise open surgery is required which may involve local bone grafting from the Coracoid process, an operation called the Latarjet procedure.
Persons involved in throwing sports can develop a tear of the cartilage, or labrum, at the top of the shoulder known as a S.L.A.P. lesion. In such cases an arthroscopic labral repair is recommended in order to return to full activity. Some patients are better off having the biceps tendon shifted to a new location or a biceps tenodesis.
The biceps tendon, a small tendon that runs through the shoulder, has the potential to become inflamed and sometimes it tears. In the early stages cortisone injections around the damaged tendon plus physiotherapy are healthy otherwise either a biceps tenotomy or biceps tenodesis may be required.
Osteoarthritis of the acromioclavicular joint usually occurs in weight lifters or those persons involved in heavy lifting. In most cases arthroscopic surgery is required to excise the distal clavicle, especially if those persons wish to continue lifting.
Shoulder rehabilitation is a very important modality of treatment for many shoulder conditions and can in some cases avoid the need for surgery. Physiotherapy is also important in the post operative period to help regain shoulder function and strength.
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