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Post-operative rehabilitation of shoulders

Postoperative physiotherapy is crucially important. Without appropriate follow-up treatment, an operation will not on its own lead to the desired result. As a doctor I can only list the essentials for a successful outcome. As a patient you must be motivated and willing to systematically follow the treatment. Great progress has been made in shoulder surgery since the introduction of early postoperative physiotherapy.

Immediately after the operation, usually on the 1st or 2nd day, we commence passive physiotherapy on a motorised dynamic splint. This involves slightly more pain at first, but this only lasts for 1-2 days, after which you and your shoulder will find these regular passive exercises both pleasant and relaxing. These exercises will also prevent the development of adhesions between tissue layers. At a later point in time, such adhesions could hamper shoulder movement.

If you meet other people who have undergone shoulder surgery when you attend physiotherapy sessions, you should always remember that postoperative treatment they are receiving cannot necessarily be applied to your own rehabilitation. In the first place, a whole range of widely differing shoulder disorders are treated by surgery, and secondly, every patient is different as regards their injury or tissue disorder and surgical reconstruction.

Allow me to give you a few tips on rehabilitation:

1. The physiotherapy during the first 6 weeks is not designed to restore your strength and mobility, but to help the tissue heal. The treatment with a motorised dynamic splint that you receive during this initial phase is intended to help maintain a certain amount of mobility in your shoulder. The management and treatment of pain is very important during this first phase. You must not actively move your shoulder during this period, only your elbow, wrist and finger joints. During this phase you will carry out the passive treatment yourself at home and not yet attend physiotherapy sessions.

2. All the exercises that you are subsequently taught in the physiotherapy sessions should also be carried out at home as often as possible. These should be practised repeatedly in all variations, but always only until it starts to hurt and no further. The exercises are intended to do you good and should not leave you in pain for hours afterward.

3. Any exercises and minor tasks that cause you no pain and are well tolerated are also permitted. But be careful not to overdo things as too much is unhealthy here too.

4. If you have exercised too much and experience pain at home or during the physiotherapy sessions, this pain is usually the result of the operated tissue swelling and of slight inflammation due to overexertion. Take the medication prescribed by your surgeon, wrap some ice in a towel and apply it to your shoulder.

5. A sensible compromise between constant movement and rest will provide the best rehabilitation for your shoulder.

6. Rehabilitation always starts with simple exercises. Do these simple exercises with increasing frequency before you proceeding to more difficult exercises. Doing a simple exercise involving a small amount of loading frequently is better than doing a difficult, forced exercise a few times.

7. Follow your physiotherapist's instructions and talk about the exercises during your physiotherapy sessions.

8. Regular check-ups with your surgeon are needed to monitor the progress of your rehabilitation and, in particular, to discuss and correct any mistakes that may have crept in. This also gives me an opportunity to consult your physiotherapist.

9. Finally, I would remind you that your physiotherapy sessions are not chat sessions. All physiotherapy patients want their rehabilitation to proceed under expert guidance so that they get well again as soon as possible. A good atmosphere is important and patients should be able to talk to and encourage each other. But it is not the right place to talk about other patients or recount horror stories to impress other patients.