Before the Surgery
Prior to your scheduled shoulder surgery, you may have the opportunity to
visit your physical therapist for a preoperative assessment. One purpose of this
visit is to get a baseline of information that includes the location and
severity of your pain, your functional abilities, your strength and available
motion of each shoulder. A second purpose of the preoperative visit is to
prepare you for your upcoming surgery. The preoperative visit is also a time for
you to begin practicing some of the exercises you'll use just after surgery.
Finally, an assessment will be made of any needs you'll have at home once you're
released from the hospital. Your therapist will be scheduled to see you on the
first day after your surgery to begin your rehabilitation program.
Inpatient Physical Therapy
You will be seen by your inpatient physical or occupational therapist one day
after surgery. If your doctor placed you in a CPM (continous passive motion)
device after surgery, your therapist will remove it to evaluate your shoulder
and to begin gentle exercises. If your arm is in a sling, it will need to be
removed when you do the exercises. The sling will need to be put back on when
you get ready to get up. You will be helped out of bed for a short outing to
begin helping you gain confidence being up and about. Along with a short walk,
you'll have the chance to use the restroom and perhaps sit in a recliner chair
for an hour or so. The distance you walk and the length of time you stay up in
the chair will increase as your condition improves. Before your therapy visit is
over, your shoulder will be placed back in the CPM or sling. Inpatient
treatments are usually done two times per day for up to four days after surgery.
By that time, you should be safe and ready to go home. You'll be on your way
home once you can safely get in and out of bed, walk 75 feet, and do the
assigned exercises by yourself.
Outpatient Physical Therapy
On your first outpatient visit, your physical or occupational therapist will
want to gather some more information about the history of your condition. You
may be given a questionnaire that helps you tell about the day-to-day problems
you are having now that you've had surgery. The information you give will help
measure the success of your treatment. You may also be asked to rate your pain
on a scale of one to ten. This will help your therapist gauge how much pain you
have now and how your pain changes once you've had treatment. Your therapist
will probably ask some more questions about your condition to begin zeroing in
on the location of your pain and to know what will be needed to help relieve it:
- How is your pain since having surgery?
- Where do you feel the pain now?
- What makes the pain better or worse?
- How do your symptoms affect your daily activities?
- Do you have pain in your arm or neck?
- Do you have swelling?
- Do you have any numbness or tingling?
Physical Therapy
Evaluation Once all this information has been gathered, your shoulder will
be evaluated.
Posture
Your therapist will begin by checking your overall posture,
including your neck and upper back alignment as well as the position of your
collar bone and shoulder blade. If there are any problems in alignment, they
will be addressed as part of your total rehabilitation program.
Observation
Your incision will be examined to see if it is clean and
that healing of the surgical area is underway. Your therapist will also look to
see if there is any swelling, bruising, or muscle wasting in or around the
shoulder joint.
Range of motion (ROM)
Next, your therapist will check the ROM in your
shoulder. In these early stages, the movements will be passive, in which only
the therapist moves the arm. In general, the movements that will be measured
include arm raising (flexion), and the inward and outward movements
(internal/external rotation). Your therapist may also want to get an idea of how
other joints around the shoulder are moving. Joints that may be examined include
the shoulder blade, collar bone, neck and elbow. Your ROM is written down to
compare how much improvement you are making with the treatments.
Strength
Your therapist will probably not test the strength of your
shoulder muscles in the early weeks of therapy. These tests are generally
avoided early on to avoid placing stress on the healing tissues. Once healing is
well underway, however, your strength will be measured in the shoulder and
surrounding muscles. Weakness in key muscles of the chest, upper back, and arm
will be addressed with a progressive strengthening program. Trained muscles will
help control your new shoulder joint, which eases pain and keeps the joint
healthy for as long as possible.
Manual examination
You may be given a manual examination of the
muscles and joints of the shoulder. Your therapist will carefully move your
shoulder in different positions to make sure that each joint around the shoulder
is moving smoothly. Your therapist will also look at the flexibility of the
muscles and tendons around your shoulder.
Palpation
he evaluation usually ends with palpation. Palpation is
when your therapist feels the soft tissues around the joint. This is done to
check the skin for changes in temperature, areas of soreness, and whether you
have swelling. Palpation is also done to find whether there are tender points or
spasm in the muscles around the shoulder.
Treatment plan
Once the examination is done, your therapist will put
together a treatment plan. The treatment plan lists the types of treatments that
will be used for your condition. It gives an indication of how many visits you
will need and how long you may need therapy. It also includes the goals that you
and your therapist think will be the most helpful for getting your activities
done safely and with the least amount of soreness. Finally, it will include a
prognosis, which is how your therapist feels the treatment will help you
improve.
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