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This page is dedicated to Healthcare Professionals

Space  professional
physiotherapist

 

Rehabilitation is essential. It fits into the concept of

Enhanced Recovery After Surgery (RAAC) .

Sometimes this rehabilitation is necessary before surgery.

Sometimes, an excellent rehabilitation can compensate for a surgical gesture.  

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Hospitalization in a Rehabilitation Center is EXCEPTIONALLY necessary.

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Rehabilitation after suture of the rotator cuff

main purpose
Softening of the joint. The sessions must be qualitative and constantly monitored by the re-educator.

To forbid
Any work in abduction and any use of weights or pulleys.

PHASE 1 (D0 to D45)

  • Splint: immobilization elbow to the body for 2 or 4 or 6 weeks (see protocol).

  • Ice, anti-inflammatories and analgesics as needed.

  • From D0 to D7 / D15 or D21 according to protocol: Exclusive self-rehabilitation
    perform all the exercises 3 times, 10 minutes a day.

    • Pendurelax: 1 min swing arm warm-up.

    • The backpack: 10 times shrug your shoulders.

    • The giraffe: 5 times stretch and gently turn the neck.

    • The wipe: 10 times gently turn your hand on a table.

    • The door opening: 10 times gently move the hand away from the body.

  • From D7 / D15 or D21 to D45: gentle rehabilitation of passive mobility 
    under the manual control of the re-educator.

    • Analgesic and anti-oedematous massage of the belt.

    • Mobilizations of the elbow and the hand.

    • Cervical postural work and scapula fixators.

    • PASSIVE movements assisted in supine decubitus elevation in the plane of choice of the scapula, (always oppose resistance to the return of the arm to position 0).

    • Exercises of manual decaptation of the scapulohumeral and manual mobilizations of the humeral head and the acromioclavicular.

  • Continuation of all self-rehabilitation exercises twice a day.

PHASE 2 (D45 to D120): Recovery of active mobility 
but not before complete recovery of passive mobility

  • Locking in the high position: in order not to stress the insertions of the rotator cuff, the work is carried out in eccentric starting from a passive elevation at 150° in a short stroke of the supraspinatus.

  • Active stabilization in high position then descent of the arm gradually controlled by the physiotherapist. No active elevation work until descent control is fully achieved.

  • Recentering of the humeral head in isometric: bringing the depressors into play during elevation movements with return of the arm to manual counter-resistance.

  • Work of the scapula fixators.

  • Intensification of the internal and external rotators in isometric.

PHASE 3 (from D120 to 6 months): Recovery of muscle strength

  • Intensification and progression of previous exercises and muscle strengthening.

  • Exercises in co-contraction deltoid – rotator cuff.

  • Proprioception exercises always involving the depressors.

Strength activities: handling heavy loads, machines, etc., can only be resumed after 6 months post-operative

Decompression for wide rupture

main purpose
The sessions must be qualitative and constantly monitored by the re-educator.

To forbid
Any work in abduction and any use of weights and pulleys.

PHASE 1: D0 to D60 Immediate rehabilitation

  • Splint: immobilization elbow to the body for 15 days

  • Ice and massage for analgesic and anti-oedematous of the belt

  • Self-rehabilitation: 3 times a day work on passive joint amplitudes: elevation, rotation and pendulum without weight

  • Under manual control of the rehabilitator:

    • PASSIVE movements assisted in dorsal decubitus elevation in the chosen plane of the scapula, (always oppose resistance to the return of the arm to position 0).

    • Scapulohumeral decaptation exercises (manual)

PHASE 2: D60 to D90 Recovery of active mobility (but not before complete recovery of passive mobility)

  • Locking in the high position: in order not to stress the insertions of the rotator cuff, the work is carried out in eccentric starting from a passive elevation at 150° in a short stroke of the supraspinatus.

  • Active stabilization in high position then descent of the arm gradually controlled by the physiotherapist. No active elevation work until descent control is fully achieved.

  • Recentering of the humeral head in isometric: bringing the depressors into play during elevation movements with return of the arm to manual counter-resistance.

  • Intensification of the internal and external rotators in isometric.

PHASE 3: from D90 Recovery of muscle strength

  • Intensification and progression of previous exercises

  • Proprioception exercises

Decompression for unruptured tendinopathy

main purpose
Softening of the joint. The sessions must be qualitative and constantly monitored by the re-educator.

To forbid
Any work in abduction and any use of weights and pulleys.

PHASE 1 (D0 to D30): Immediate recovery of passive mobility

  • Splint: immobilization elbow to the body for 8 days.

  • Ice cream and massage for analgesic and anti-oedematous of the belt.

  • Self-rehabilitation. Work of passive articular amplitudes 3 times a day: elevation in lying position, rotation and pendulum without weight.

  • Under manual control of the rehabilitator:

    • PASSIVE movements assisted in supine decubitus elevation in the plane of choice of the scapula, (always oppose resistance to the return of the arm to position 0).

    • Exercises of decaptation of the scapulo-humeral (in manual).

PHASE 2 (D30 to D60): Recovery of active mobility
but not before complete recovery of passive mobility

  • Locking in the high position: in order not to stress the insertions of the rotator cuff, the work is carried out in eccentric starting from a passive elevation at 150° in a short stroke of the supraspinatus.

  • Active stabilization in high position then descent of the arm gradually controlled by the physiotherapist. No active elevation work until descent control is fully achieved.

  • Recentering of the humeral head in isometric: bringing the depressors into play during elevation movements with return of the arm to manual counter-resistance.

  • Intensification of the internal and external rotators in isometric.

PHASE 3 (from D90): Recovery of muscle strength

  • Intensification and progression of previous exercises.

  • Proprioception exercises always involving the depressors.

adhesive capsulitis

Rehabilitation of adhesive capsulitis: main goal

Purely physiotherapy management of adhesive capsulitis combining mobilization sessions beyond the pain threshold and controlled self-rehabilitation.

Rehabilitation of adhesive capsulitis: three fundamental principles

  • Patient education: the pain is caused by distention of the capsule. Unavoidable character of pain during rehabilitation.

  • A well codified physiotherapy: 3 weekly sessions, manual passive mobilizations.

  • Controlled self-rehabilitation: exercises performed by the patient alone, at home, at least 3 times a day. Regular iterative assessments carried out by the re-educator.

Programming of rehabilitation sessions for adhesive capsulitis

1. Preparatory work: Fight against painful phenomena.

  • Cervicoscapular decontracting massages: trapezius, supra and infraspinatus fossae, arms.

  • Pendulum movements.

  • Self-mobilizations in anterior elevation.

  • Specific mobilizations: the scapulo-thoracic, the coraco-humeral ligament, the gleno-humeral joint.

  • Manual decoaptation and soft and progressive capsular stretching (Mennell type).

2. Recovery of joint amplitudes: rehabilitation aims to distend the retracted joint capsule.

  • Anterior elevation: Stretching of the posterior and inferior capsule: dorsal decubitus, scapular plane, decaptation, control of the humeral head, distal humeral grip, internal rotation for the posterior capsule.

  • Extension: Stretching of the antero-superior capsule: dorsal decubitus, contract-release.

  • External rotation: stretching of the anterior capsule and interval of the rotators: sitting position, control of the positioning of the humeral head.

  • Pure abduction: stretching of the lower capsule and omo-humeral space: seated position, fixation of the scapula, deep massages of the circles, prevention of the ringing of the scapula.

The success of this rehabilitation is based on the following rules

  • Pain management.

  • Effectiveness of pain treatment.

  • Patient motivation, self-rehabilitation.

  • Adapt to the evolutionary stage of capsulitis: hyperalgesic phases, calm phases, phases of transient regression of amplitudes.

  • Flexibility and tact.

Unoperated subacromial impingement

main purpose
Rehabilitation must be manual, personalized and associated with self-rehabilitation to be practiced at home 3 times a day.

To forbid
Any pulley therapy and any exercise with dumbbells.

Principles

  • Achieve full passive range of motion.

  • The position in dorsal decubitus makes it possible to avoid the possible presence of compensations and facilitates work in subacromial decoaptation.

  • It must be associated with maneuvers intended to release the scapula on the costal grill.

  • The active work will be above all a muscular awakening of the humeral head depressors and the scapula fixators with awareness by the patient of the "good gesture".

PHASE 1: Compromise between passive and active techniques

  • The recovery of passive mobility continues until complete amplitudes are obtained, especially in rotation.

  • Active articular recentering of the humeral head.

  • Assimilation of good upper limb elevation kinetics.

Depending on the pain, this work is sought first in the supine position, then in the semi-sitting position and finally in the sitting position (first use visual feedback).

PHASE 2: Mainly active techniques

  • Reinforce the lock in the high position and the humeral head.

  • Strengthen the internal rotators in concentric and eccentric first elbow to the body to finish in position RE3.

  • Reinforcement of the scapula fixators.

STAGE 3: Proprioception

  • Proprioceptive work with, then without visual reference to finish by integrating gestures that are more and more restrictive for the articulation.

  • Correction of overall posture.

  • Correction of kinematic defects of the glenohumeral, scapulothoracic and acromioclavicular.

LATARGET stopper

PHASE 1 (D0 to D15)

  • Immobilization elbow to the body for 15 days.

  • Ice, Anti-inflammatories and analgesics as needed.

  • Regular release of the elbow.

STAGE 2 (D15 to D90)

  • Spontaneous resumption of the movements of daily life.

  • Avoid any forced movement especially in external rotation.

  • Gentle and progressive muscular awakening of the deltoid and rotators.

  • Very careful work on the amplitudes (unless otherwise indicated) in order to favor ligament healing.

  • Painless work of external rotation elbow to body and internal rotation.

  • No active external rotation for 6 weeks.

PROHIBITED movements for 3 months strict
1. Armed in abduction and external rotation.
2. Retropulsion of the arm in extension.

PHASE 3 (from D90)

  • Muscular and proprioceptive strengthening.

  • Complete the recovery of passive range of motion without forcing external rotation and arm strength.

STAGE 4 
Resumption of sports activities according to medical advice.

Arthroscopic Bankart

PHASE 1 (D0 to D30)

  • Immobilization elbow to the body for 1 month.

  • Ice, Anti-inflammatories and analgesics as needed.

  • Regular release of the elbow.

PHASE 2 (D30 to D90)

  • Spontaneous soft and progressive resumption of the movements of daily life.

  • Avoid any forced movement especially in external rotation.

  • Gentle and progressive muscular awakening of the deltoid and rotators.

  • Very careful work on the amplitudes (unless otherwise indicated) in order to favor ligament healing.

Movements prohibited for 3 months strict
1. Armed in abduction and external rotation.
2. Retropulsion of the arm in extension.

PHASE 3 (from D90)

  • Complete the recovery of passive mobility without forcing external rotation.

  • Muscular and proprioceptive strengthening.

STAGE 4 
Resumption of sports activities according to medical advice.

Anatomic prostheses

Rehabilitation phases after an anatomical shoulder prosthesis 

Phase 1 (D0 to D30)

  • Splint: immobilization elbow to the body for 21 days.

  • Ice, anti-inflammatories and analgesics as needed.

  • Cervicodorsal massage with maintenance of the underlying amplitudes.

  • Mobilization of the scapula (active and passive).

  • Anterior elevation: passive mobilization in a strictly recumbent position, in the chosen plane of the scapula, in neutral rotation.

  • Assisted active external rotation, elbow to body, limited to 0° external rotation.

For 1 month protect the sutured subscapular. 
No internal rotator work. 
Caution in external rotation.

Phase 2 (D30 to D90)

The objective is muscle recovery after recovery of passive amplitudes.

  • Eccentric isometric muscle work.

  • Active movements helped by increasing the amplitudes.

  • Strengthening of the rotators.

  • During this phase, resumption of functional gestures, occupational therapy and proprioception.

Pulley therapy is strictly prohibited.

Rehabilitation protocol after anatomical shoulder prosthesis

Reverse prostheses

REHABILITATION PHASES AFTER REVERSED SHOULDER PROSTHESIS

PHASE 1 (D0 to D 30)

  • Splint: immobilization elbow to the body for 15 days.

  • Ice, anti-inflammatories and analgesics as needed.

  • Cervicodorsal massage with maintenance of the underlying amplitudes.

  • Mobilization of the scapula (active and passive).

  • Assisted active elevation with co-contraction of the deltoid to stabilize the prosthesis.

  • Assisted active external rotation, elbow to body, limited to 0° external rotation.

We encourage the functional gestures of daily life and occupational therapy in order to regain good functional autonomy as soon as the immobilization is over.

For 1 month, the sutured subscapular must be protected. 
No internal rotator work. 
Caution in external rotation
No pendulum for a reverse prosthesis.

PHASE 2 (D30 to D90)
Objective: muscle recovery after recovery of passive amplitudes.

  • Eccentric isometric muscular work (in particular of the deltoid).

  • Active movements helped by increasing the amplitudes.

  • Strengthening of the external rotators.

  • Progressive support for increasing scapulo-thoracic mobilization during elevation.

  • Recovery of amplitudes in internal rotation (active and passive).

Pulley therapy is strictly prohibited.

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