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The three phases of shoulder rehabilitation

Phase 1
This is the immediate postoperative period. Before your operation you will have spoken to your anaesthetist, and he will have explained - if this is necessary in your case - that he will give you a nerve block before your operation to control the pain. This involves inserting a local anaesthetic close to the nerve bundle that supplies the arm and shoulder to be operated on, thus ensuring that the arm remains pain-free during and after the operation. This pain treatment immediately after the operation is very important.

Having relaxed muscles and a correctly positioned arm are key factors. When you come round from your anaesthetic your arm may be positioned on a cushioned abduction splint. This wedge holds the arm slightly away from the body, thereby preventing excessive tension on the operated tissues and also any prohibited movements during the initial postoperative period. In other shoulder operations the arm is secured to the body in an "Ortho-Gilet", a special immobilising sling with Velcro fastenings. The postoperative period will differ depending on the particular operation. Since what may prove beneficial to one shoulder can harm another, it is very important that you discuss your subsequent physiotherapy with your surgeon and not with "just anybody". Most shoulder operations involve a hospital stay of around a week. Wound healing, starting passive physiotherapy and learning to use a motorised Arthromot splint without assistance are all important factors during this period. During your hospital stay you should also discuss any further questions you may have with your surgeon. The nursing staff will also be able to give you some valuable tips on rehabilitation at home. When you are discharged from the hospital, you should be aware of the follow-up process and should have been given an appointment to see your surgeon again. Since surgical treatment of shoulders is a time-consuming process that starts with the operation and continues throughout physiotherapy, patients must have a clear idea about the whole process and know who to contact if they encounter problems. The first people to contact are always your surgeon, physiotherapist and GP. When you return home, you will continue the passive exercises six to ten times day for 15 to 30 minutes a time. Patients who require a cushioned abduction splint will be given a plastic-coated wedge for use in the shower at home.

Phase 2
The physiotherapy you receive is designed to restore full mobility, including the ability to raise your arm above the horizontal. Intensive exercises at home and during physiotherapy are a feature of this phase. The procedure will vary considerably during this phase, depending on the disorder or injury to be treated. Tissue healing is over by this stage. The elasticity and loadability of the tissue now has to be restored by means of extensive physiotherapy. The exercises can also be performed in the bath and with items of equipment. Aqua aerobics has recently proved to be very effective. At this stage you will probably not be able to work, particularly if you work in a skilled trade or have to carry out domestic chores. Although you will certainly be able to gradually resume many tasks, your shoulder will still be unable to bear any load at this stage and it will not have sufficient raw, general strength to allow you to start work. All activities during this phase should be carried out as treatment and in a way that is geared to rehabilitating your shoulder.

Phase 3
In phase three your shoulder is returned to full strength and fitness, and you reintegrate shoulder movements into everyday activities. This phase will vary from patient to patient depending on your physical or sporting activities. There is a big difference between the exercises given to someone whose job involves physical labour, e.g. in the construction industry, and the exercises given to someone who work in an office. The aim is to enable you to return to work full time. You will increasingly do your exercises out independently at home or at a gym. Your physiotherapist will now be mainly responsible for monitoring your treatment. The procedure in this phase will also differ depending on the type of operation you have had or how long you had your shoulder condition before your underwent surgery.

The worse and longer-lasting the damage before the operation, the more your shoulder will have adapted itself to the situation and the more difficult and longer this phase of rehabilitation and reintegration will be. Since it can take six months for the bursa to reform underneath the acromion, patients should not expect to experience completely pain-free shoulder mobility until the end of this period. You will be able to start working full time again after 3-6 months, depending case on the type of operation you have had. Since an operated shoulder can continue to make continual slight improvements for up to a year after the operation, a final evaluation only makes sense after one year, although patients do not usually notice these final small adjustments and improvements. Even when your treatment and rehabilitation have been completed, you should never forget that you have a reconstructed shoulder which will always require slightly more care than other joints. After all, second or multiple procedures on a joint are always more difficult than first operations and are often unable to produce the same end result.