therapie after shoulder surgery

[Henne87]

Hello everybody,

I´m new in this forum. I´m from germany and I study physiotherapy in netherlands. First I need help myself

I had a surgery of my shoulder after 3 dislocations. The labrum was torn in anterior/inferior position and there was a HAGL-lesion.

Now the surgery is 4 weeks ago. When the surgery is 6 weeks ago I´m "allowed" to begin with easy exercises. In the beginning I know it´s better to make the exercises slowly and carefully. But what is the best method to make the shoulder stable? The first therapie I had after my first dislocation, there I did the exercises only slowly, 3 series with 20 repititions for example external rotation.

What do you think is the best method to get the shoulder stable over long time?

After the surgery I was and am not allowed to do external roation and retroversion for 6 weeks. While doing the threrapy the physio said I should make this up to 10°. That´s minimal but the doctor who is specialist said I shouldn´t do this. Anyway I did it 2 times. Firstly 2,5 weeks postsurgical and secondly 4 weeks postsurgical. I just put the arm 10 times to 10° retroversion. I had no pain but I´m still afraid sinds 2 days to have a labrumtorn again. It feels not different than before I did it, but I´m just afraid because the specialist did forbit it. Is anybody in this forum who understands the moving of the caput humeri very goed and call tell if an injury is possible?

thanks for reading and giving answer,

Henrik

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[shasadah]

hmm...I think, as u did active external rotation only 10 degrees on 3rd post op week and it was pain free so there is almost no chance to tear the labrum again because ist 10 degrees from the nutral position will not generate any significant pressure on the ant. structures to the head of hum and specially if its been three weeks gone.
usually after 4th week pt. can start active external roation in painfree rang and that is almost ist 10 to 15 degrees.

gud luck

[Henne87]

hey,

thanks for answering, I did no external rotation. It was 10 times Retroversion/Extension. The problem with pain is, that the labrum isnt´t innervated very well. I also did´t feel anything while torning it for the first time...But if there is no big stress on the labrum while doing this thats good.The doctor who made the surgery is one of the best specialists in germany and also international in great demand. So I think if he says that I may not do external roation and extension for 6 weeks weeks, there is a reason for it. Normally u should stress healing structures functionally, but i guess that the labrum isn´t strong enough in the first time...

Does anybody know how to train the external/internal rotation best with refernce to series and repititions?

thanks

[Judith Mollet]

Firstly, as you said, if the surgeon says wait a certain amount of time before you do something he has a reason for it. He saw the damage inside and knows his work in trying to mend it!
Shoulder stability will depend on the correct rehabilitation of your rotator cuff muscles. A HAGL lesion may have included your subscapularis muscle tendon, check out on that. Rehab usually should include your "scapula setting" and scapula function as well. It's not just a question of how many repetitions IR ER muscles but the quality of activity in the rotator cuff to provide and maintain enough "zentrierung" of the joint throughout range etc.. Look for a physio either with excellent "Kinetic Control" experience in muscle imbalance rehab or, although I don't do it myself, "Sohier Konzept" trained physios will look for "zentrierung" and so on. You need, at the beginning, a tailor made assessment of YOUR current shoulder function and hands on individual correction. Aim for excellence. You will need your shoulder for a few years yet. Good luck