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Had shoulder replacement after a fall. Constant pain. Suggest physical therapy treatment?

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I had my shoulder replaced after a nasty fall and have not yet started PT. This happened about a month ago and there is still consant pain - at about a 4 on a scale of 1 - 10.
Any insights on pain control - and at home Physical Therapy (PT) that I should be doing?
Posted Thu, 31 Oct 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 1 hour later
Brief Answer:
Pain will subside as the time progresses.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

As you have underwent a major surgical procedure (shoulder replacement), generally pain tends to be on the higher side during the early post operative period. Hopefully within 8-10 weeks, you should become pain free.

I personally prefer tramadol and acetaminophen combination for all my elderly age group patients undergoing major surgical procedures. The choice of painkillers differ from surgeon to surgeon based on a selected patient and their comorbidities. Ice packing is one of the simple and effective way to control pain and it also calms down the inflammation. Regarding the pain control, you have to consult your treating doctor and he will prescribe the medications which suits you better.

The physiotherapy protocol after shoulder replacement procedure is as follows -

• Pendular exercises in forward leaning
• Passive/active assisted flexion either in lying, sitting or standing as pain allows.
• Passive/active assisted external rotation sitting with a stick (range as per op. note)
• Cervical, elbow and wrist exercises.
• Once stitches have been removed begin scar massage.

• Sling to be worn constantly for 4 weeks, including night times
• No lifting for 6 weeks
• No active XXXXXXX rotation for 6 weeks
• No driving for a minimum of six weeks if right arm, eight weeks if left.
• Advice on sleeping and pillow positions, try and maintain elbows higher than shoulders.
• Clean under the armpits as this is a common area of infection.
• Try to wear loose clothing for ease of access to the shoulder.
• Sitting with arm supported, i.e. with pillows.
• Take painkillers regularly as prescribed and time exercises for half an hour after administration.

Exercises for increasing range of motion in the shoulder should be done as follows

• Pulleys to encourage flexion only if done correctly and without pain.
• Slide up wall/along table top.
• Active assisted abduction with the use of a pole.
• Begin active XXXXXXX rotation after 6 weeks.

Gentle resisted exercises starting with:
• Isometrics for rotator cuff.
• Short lever exercises for deltoid, starting in lying and then progressing to sitting.
• Resisted exercises with free weights, depending on age, pathology and occupation.

Its always better to perform all these activities under the guidance of a qualified person.

Hope I have addressed your query.


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