Surgeries

PHASE 1 (D0 to D15)

• Immobilization elbow to body for 15 days.
• Ice, anti-inflammatory and analgesics as needed.
• Regular release of the elbow.

PHASE 2 (D15 to D90)

• Return to the movements of everyday life.
• Avoid any forced movement, especially in external rotation.
• Gentle and progressive muscle stimulation of the deltoid and rotators.
• Very careful work on amplitudes (except specific indications) to encourage ligament healing.
• Painless work of external rotation with the elbow to the body and internal rotation.
• No active external rotation for 6 weeks.

Movements PROHIBITED for 3 months:

1. Brace in abduction and external rotation.
2. Arm backward thrust in extension.

PHASE 3 (from D90)

• Muscular and proprioceptive strengthening.
• Complete recovery of passive joint amplitudes without forcing on the external rotation and the arm.

PHASE 4

Resume sports activities according to medical advice.

• The surgeon installs it by passing through or disinserting the subscapularis. The latter serves as a neo joint and needs to be constantly refocused by the cuff (the supraspinatus, but also the subspinatus and subscapularis).
• It is therefore necessary to seek joint congruence of the glenohumeral at all costs and to prohibit any anterior decoaptation and untimely external rotation movements!
• It is necessary to associate sliding in the opposite direction to mobilization.
• By eccentricating the center of rotation towards the outside, it allows the mobilization of the humeral segment by the deltoid muscle in all amplitudes.
• The areas of weakness created by the surgery are the muscles that are disinserted or severed in the anterior approach. External rotations and horizontal abductions should therefore be moderated until D45 and monitored thereafter.

Rehabilitation is done in 2 phases.

PHASE 1 (Day 0 to Day 30)

• Splint: immobilization of the elbow to the body for 21 days.
• Ice, anti-inflammatory and analgesics as needed.
• Cervico-dorsal massage with maintenance of the underlying amplitudes.
• Mobilization of the scapula (active and passive).
• Active assisted lifting with co-contraction of the deltoid to stabilize the prosthesis.
• Mobilization taking into account the concave-convex law.
• Combine superior glides with abduction lifting.
• For 1.5 months, the subscapularis must be protected to avoid a serious problem of instability.
• No active work of the rotators.
• No external rotation beyond the neutral position.

PHASE 2 (D30 to D90)

Functional gestures of daily life and occupational therapy are encouraged. The objective is muscular recovery after recovery of passive amplitudes.

• Isometric muscle work.
• Assisted active mobilization with the aim of recovering amplitudes. Always accompany the passive and active assisted abduction movement with an upward slide of the humeral head due to the convexity of the glenoid.
  • Associate inferior glides with abduction elevation.
  • Associate anterior slippage with external rotation.
  • Combine posterior glides with internal rotation.
• Strengthening of the rotators.
• During this phase: resumption of functional gestures, occupational therapy and proprioception.
• Pulley therapy is strictly forbidden.

• The surgeon places it without suturing the cuff (the supraspinatus tendon). The cuff is no longer needed because the neo joint no longer needs to be permanently re-centered by the cuff (the supraspinatus).
• However, joint congruence of the glenohumeral joint must be sought at all costs and any decoaptation must be prohibited!
• Sliding must be combined with mobilization in the same direction.
• By eccentricating the center of rotation towards the outside, it allows the mobilization of the humeral segment by the deltoid muscle in all amplitudes.
• The areas of weakness created by the surgery are:
• The subglenoid area (notch in the subglenoid of the scapula), in which the prosthesis can tap if adduction to the body is too pronounced. Monitor the return of abduction and elevation.
• Uninserted or severed muscles are in the anterior approach. External rotations and horizontal abductions should therefore be moderated ++ until D 45 and monitored thereafter.

Rehabilitation is done in 2 phases.

PHASE 1 (Day 0 to Day 30)

• Splint: immobilization of the elbow to the body for 21 days.
• Ice, anti-inflammatory and analgesics as needed.
• Cervico-dorsal massage with maintenance of underlying amplitudes.
• Mobilization of the scapula (active and passive).
• Active assisted elevation with co-contraction of the deltoid to stabilize the prosthesis.
• Mobilization taking into account the concave-convex law.
• Combine superior glides with abduction elevation.
• For 1.5 months, the infraspinatus and the lesser tuberosity must be protected and reinserted, if possible.
• No active work of the rotators.
• No external rotation beyond the neutral position.

PHASE 2 (D30 to D90)

Functional activities of daily living and occupational therapy are encouraged. The goal is muscle recovery after recovery of passive range of motion.

• Isometric muscle work.
• Assisted active mobilization with the aim of recovering amplitudes. Always accompany the passive and active assisted abduction movement with an upward slide of the humeral head due to the convexity of the glenoid.
• Combine superior glides with abduction elevation.
• Associate posterior slippage with external rotation.
• Combine anterior glides with internal rotation.
• Strengthening the rotators.
• During this phase: resumption of functional gestures, occupational therapy and proprioception.
• Pulley therapy is strictly forbidden.