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Reverse shoulder replacement for fracture post operative guidelines- Mr Thomas TresederName: Date of Surgery Comments: Contact: tomtreseder@.auOur postoperative RSR physical therapy treatment protocol is outlined in 4 phases: Phase I: immediate postsurgical/joint protection and recovery of passive ROMPhase II: isometric and and neuromuscular control work startedPhase III: moderate strengthening progressing as toleratedPhase IV: return to function and maximization of strength and motion, independent/progressive home program. Phase 1: Day 1 - 4 weeksSwelling management (tubigrip from fingers to axilla, Ice QID, compression) and scapula position are key goals. Prevention of capsular stiffnessOccupational Therapy home assistance and assessmentSling worn with body belt- out of sling for hygiene and elbow and hand ROM QIDWrist/hand/finger exercisesElbow flex/ext, pro/supinationShoulder girdle exercisesScapula setting exercisesPendular exercisesPassive ROM as limited by pain in all directions as tolerated with external rotation no more than 0 degrees to protect subscapularisNo AROM, AAROM or activation of rotator cuff No passive ER past 20 degreesPhase 2: 4-6 weeks:An XRay will be performed to ensure tuberosities are still well located prior to progression to phase 2Do not force or stretchGentle isometric exercises in neutral as pain allowsWean off sling (eg use for ouside trips until 6 weeks off for sleep and around house)Begin gentle active assisted exercises ensuring glenohumeral movement, not scapulothoracic.Phase 3: 6 weeks – 12 weeks:Repeat XR at 8 weeksBegin active assisted exercises and cease ER restrictionsProgress to full active exercises in all rangesBegin rotator cuff strengthening (pain free)Closed chain exerciseBegin stretching the capsuleBegin proprioceptive exercisesPhase 4: 3 months +Continue strengthening and ROMIncreased emphasis on function retrainingImprovement likely untill months post operatively?Milestones4 Weeks50% pre op passive ROM6 WeeksPassive ROM 80% to pre op level12 WeeksActive ROM 90 degree FF and 80 degree of abduction Return to functional activitiesDriving ?????????? ???????????6 WeeksSwimming?????? ???????????Breaststroke:?? 6 weeks Freestyle:????????? 3 monthsGolf???????????????? ?????????? 3 MonthsLifting ??????????? ??????????? 3 Months (guided by the strength of the individual patient)Return to work???????????Sedentary job:?3 weeks?Manual job: individualised ................
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