This protocol was developed to provide the patient a guideline of pre- and post-operative care following a total shoulder arthroplasty (shoulder replacement). These instructions do NOT replace the instructions of either your physician or physical therapist.

Overall goals of the rehabilitation process are to protect the healing structures of the shoulder replacement, control pain and swelling, regain shoulder range of motion, regain normal upper extremity strength and endurance, and achieve the level of function based on the orthopedic and patient goals. You will be in a shoulder abduction brace following surgery. The duration of the brace use and progression of rehabilitation will be individualized to protect your shoulder from tendon, muscle or bone disruption. The rehabilitation process for a shoulder replacement is a lengthy process and the patient will likely improve for up to one year post-operatively.

Prior to your surgery you will be contacted by a pre-operative nurse at the surgical facility to go over the specifics of your surgery. You may require pre-operative testing / clearance from your primary care physician and any other specialist due to your other medical conditions.

If you or a family member has recently been diagnosed with a staph aureus or MRSA infection, please inform us immediately as this may increase your risk of post-operative infection. Pre­operatively we may consult an infectious disease physician for evaluation and treatment prior to surgery.

There is the potential for the development of blood clots and pulmonary emboli. A variety of medications can be used as prophylaxis, the patient can consider these and discuss their options with their medical physician. The day of surgery we will review this again and determine the patient's wishes

A short-term hospitalization stay of one to two days is typically required. Therapy will be initiated while in the hospital and continued as an outpatient. No active range-of-motion is allowed until 6 weeks post-operatively to allow for tendon healing. Your motion will be progressed with the assistance of your therapist.

To minimize risk of infection post-operatively, I recommend patients use prophylactic antibiotics before dental and/or invasive procedures. I recommend annual follow-up with radiographs to assess the implant for wear and loosening.

Please visit the American Academy of Orthopedic Surgeons' website for further treatment discussion, surgical information and instructional videos.

www.aaos.org

PRE-OPERATIVE CARE

Medications to AVOID prior to surgery:

• If you are taking blood thinning medications such as Coumadin® or Plavix® you must discuss this with your medical physician.

• All aspirin and aspirin-containing drugs, and non-steroidal anti-inflammatory medications, should be discontinued one week prior to surgery. These medications can interfere with blood clotting.
• Examples of medications you should not take include:

• Tylenol® (acetaminophen) products are safe to use if you need a mild pain reliever.
• Insulin and oral hypoglycemic medications should not be taken the morning of surgery unless you are specifically directed otherwise
• Herbal medications or preparations should be discontinued two weeks prior to surgery
• Diet medications taken for weight loss should be discontinued two weeks prior to surgery
• Dietary supplements should not be taken the morning of surgery
  
  

The Night Before Surgery:

• Do not eat, drink, or smoke anything after midnight. This includes:

The Day of Surgery:

• If you usually take heart, blood pressure, acid reflux, hiatal hernia or asthma medications in the morning, these should be taken with a sip of water, otherwise no other medications should be taken
• You may shower or bathe and brush your teeth (do not swallow the water)
• It is recommended to do a Phisohex® or Hebacleanse® shower prior to surgery to decrease the risk of post-operative infection
• Do not wear makeup, lipstick, perfume, cologne, deodorant or nail polish
• Do not wear jewelry including earrings, wedding rings, etc.
• Please leave all valuables at home
• If you wear glasses please bring an eyeglass case to the hospital with you, do not wear contact lenses the day of surgery
• Please limit the number of people, one or two, who accompany you to the hospital for your surgery
• Your Anesthesiologist will discuss with you the utilization of a nerve block. This is performed to limit post-operative pain. A nerve block can last anywhere from 2-36 hours post-op. You may experience such feelings as numbness, tingling, heaviness, weakness and a feeling that your arm has "fallen asleep". Other common side effects include mild shortness of breath, a hoarse voice, blurry vision and drooping on the same side of your face as the nerve block. These usually resolve within 12 hours post-op. If the symptoms do not go away or the block lasts longer than 48 hours, please contact your physician. If you experience severe or prolonged shortness of breath, please go to the emergency room.

• Goals will focus on:
  • Advance ROM following restrictions to full motion
  • Gradually restore active motion
  • Control pain and inflammation
  • Allow continued healing of soft tissue
  • Re-establish dynamic shoulder stability
  • Gradually restore shoulder strength, power and endurance
  • Gradually return to functional activities with involved upper extremity
• Precautions:
  • While lying supine, a small pillow or towel should be placed behind the elbow to avoid shoulder hyperextension / anterior capsule stretch.
  • No heavy lifting of objects (no heavier than a cup of coffee)
  • No supporting of body weight by hand on involved side for three months
  • No sudden jerking motions
• Criteria for progression:
  • Tolerates active assisted / active range of motion, and strengthening
  • Able to actively forward elevate shoulder to 120 degrees with good mechanics
  • Has achieved active ER / IR as previously determined
    
    

Post-Op >12 weeks:

• Goals:
  • Maintain non-painful ROM
  • Enhance functional use of upper extremity
  • Improve muscular strength, power and endurance
  • Gradual return to more advanced functional activity
  • Progress weight-bearing exercises as appropriate
  • Establish a home program
• Precautions:
  • Avoid exercise and functional activities that put stress on the anterior capsule and surrounding structures. Example- no combined ER and abduction above 80 degrees of abduction.
• Criteria for discharge from formal physical therapy:
  • Patient able to maintain non-painful AROM
  • Maximized functional use of upper extremity
  • Maximized muscular strength, power and endurance
  • Patient has returned to advanced functional activities
    
    

Post-Op 4-6 months:

• Return to recreational hobbies, gardening, sports, golf, tennis
• Improvement continues for 12 months post-op
  
  

Post-Op 1 year:

• Return for x-rays to check implant wear and loosening