Shoulder Replacement Protocol

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When a person’s shoulder is injured, it affects their range of motion, limiting their ability to perform regular activities like lifting, exercising, or playing sports.

These limitations can impact a person’s ability to work, play with their children, or even dress themselves without experiencing pain and discomfort.

For these reasons, depending on the location, type, and severity of the shoulder injury, doctors often recommend shoulder replacement surgery.

What to Expect from Total Replacement Shoulder Surgery

shoulder replacement protocol

If you suffer a shoulder injury that results in severe discomfort or extensive damage, your physician may recommend total replacement shoulder surgery.

To achieve this, healthcare providers will follow total shoulder replacement protocol to completely remove the damaged parts of your shoulder, including the shoulder joint, and replace them with artificial components, commonly referred to as “prosthesis”.

The entire procedure typically takes about two hours, but patients should expect to remain in hospital for several hours following their surgery, as they will need to be monitored while the anesthesia wears off, and may need additional follow up for pain management.

The Recovery Process

After the surgery itself, shoulder replacement protocol continues for 12 weeks, and sometimes longer, depending on if any complications occur.

These weeks are often broken down into phases so that patients can better understand what to expect during each stage of healing.

The four rehabilitation stages are as follows:

Phase 1 (0-4 Weeks Post-Surgery)

During this phase, the patient will be required to keep their arm in a sling. Brief periods of time without the sling are okay while the patient is at home, but movement must remain limited and the elbow should remain tucked against the side of the body at all times.

Patients are also advised not to submerge their shoulder under water during this period.

Lastly, patients will be expected to apply ice or cold packs to their shoulder on a regular basis. Typically this will need to be done multiple times a day, for 15-20 minutes each time.

Remember, total shoulder arthroplasty protocol exists to ensure you experience a full, healthy recovery, so following guidelines is crucial and should not be overlooked.

Phase 2 (4-6 Weeks Post-Surgery)

This is often referred to as the “early strengthening phase”, since it is when the soft tissue of the shoulder will have had enough time to heal, and the patient can begin to gently improve their range of motion.

However, in order to avoid common shoulder replacement problems, it is imperative that the patient does not over-extend the arm or lift anything heavier than a cup of coffee.

The sling must also still be worn while sleeping during this phase.

Lastly, this is when patients will begin working with a physiotherapist to perform light shoulder isometrics, which will help to slowly restore mobility and strength.

Phase 3 (6-12 Weeks Post-Surgery)

The third phase of total shoulder protocol focuses on building upon the conditioning of the isometric exercises, while enhancing strength, power, and endurance on a step-by-step basis.

During this time, patients should still be using the sling at night, and are restricted from lifting objects that weigh more than 3 kilograms.

This is also where scapular strengthening and IR strengthening will be progressed, in order to restore the shoulder to its original potential.

Phase 4 (12+ Weeks Post-Surgery)

The goal of this final phase is to get the patient to a point where they no longer experience pain or discomfort when actively using their full range of motion.

Of course, depending on the individual’s unique surgery experience, this portion of their total shoulder replacement rehab protocol will vary.

The patient’s healthcare team, along with their physiotherapist, will assess their progress to see if they have returned to more advanced functional activities.

If so, the sling can be removed at this point.

It will be likely be recommended that the patient continue progressive deltoid strengthening exercises, as well as standing glenohumeral flexion and extension with resistance tubing.

It’s important for patients to remember that shoulder replacement protocol will vary on a case-by-case basis.

For example, patients who work desk jobs where minimal movement is required may be able to return to work in as little as 2-4 weeks, while those who work more labor-intensive jobs could be off the job for up to six months.

Additionally, there are a range of factors that can impact how fast or slow an injury heals. Smokers, for example, are at an increased risk of complications, particularly when bones have been damaged. Patients who are overweight are also at an increased risk for complications. In fact, for every one-unit increase in body mass index (BMI) after 30, there was a five percent increased risk of revision for mechanical failure.

It is important for patients to discuss all risk factors with their physician before making the decision to undergo total shoulder replacement surgery, and educate themselves on all possible outcomes and scenarios.

With all this being said, shoulder surgeries are one of the most successful operations a person can undergo.

To be more precise, the complication rate associated with total shoulder replacement surgery is less than five percent, and this number can be decreased even further when proper total shoulder replacement precautions are followed.

The Two Most Common Types of Shoulder Injuries

So what are the types of injuries that can result in this type of treatment?

In most cases, shoulder injuries can be grouped into one of two two categories:

1. Acute Shoulder Injuries

This type of shoulder injury is typically the result of sudden, unexpected damage to the shoulder area.

Common causes of acute shoulder injuries include:

  • Falls
  • Contact sports
  • Bicycle accidents
  • Lifting heavy objects
  • Car accidents

2. Overuse Shoulder Injuries

Unlike acute shoulder injuries, this type of damage to the shoulder is caused by repetitive activities that deteriorate the muscles, ligaments, bones, or cartilage within the affected area.

Common causes of overuse shoulder injuries include:

  • Long-term sport careers (Tennis players, basketball players, boxers, etc., are at a heightened risk due to repetitive arm movements.)
  • Weight lifting
  • Construction work (Frequently painting walls, hammering, etc.)
  • Poor posture (Frequent slouching while sitting, working at a desk for an extended periods of time, etc.)

From time to time, shoulder injuries can occur that do not fall into one of these two categories, such as injuries caused by systemic diseases, like arthritis or osteoporosis. But these conditions account for a smaller portion of shoulder surgeries.