EXERCISES

The first exercises you do after surgery will be the exercises under Phase 1.  You will do these 3- 4 times a day.  Dr. Bramlett will let you know when to start your Phase II exercises.

Phase I

1. Clasp your hands together at the chest and slowly slide hands across a table and back to your chest.  This should take approximately one minute at the beginning. Remember to start out doing 2-4 of these and increase daily until you can do these exercises 10 times a session.  If you put a towel under your hands your hands will slide across and around your table easily.

Repeat 5-10 times.

1. With your hands still clasped together at the chest slowly slide your hands in a wide clockwise circle around a table until you make a complete circle.  Now slide your clasped hands in a counter clockwise circle.  This should take approximately 1 minute.  Repeat 5 – 10 times. 

1. At first, this 3rd exercise is easier done while lying down in bed. With your hands clasped together at the chest keeping elbows level with your hands slowly move hands and elbows from your chest to your chin, then to your nose, then to your forehead.  Repeat 5-10 times.

After you have returned for your first post-op appointment and have mastered the Phase I exercises Dr. Bramlett may add the following exercise regimen.  You will do these exercises 3-4 times during the day for 10 – 15 minutes each.

Phase II

• With both hands together, standing 6 –8 inches from the wall, lift your hands straight up above your head. Separate your hands and rest them against the wall. Now, with both hands on the wall, make small, slow 8”-12” circles on the wall as if you were scrubbing it. If you are tired, rest your hands against the wall but be careful not to bring them down until you are finished. As this becomes easier, advance to making circles with four fingers instead of your hands, then 3 fingers, then 2 fingers, and then one finger.  Now progress to lifting your hands 1” off the wall, making small, slow 8” to 12” circles.

Our team has developed this treatment guide in order for you to have a

quick reference for your care and recovery.  We have made a very simple

protocol to enable an easy recovery.  After over 20 years of practice, I have

developed this protocol to allow you the most efficient and safe recovery.

Shoulders are complex, but with you following instructions and Phase 1

exercises, you will have an easier recovery.  It is my pleasure to be able

to diagnose and treat our patients, and we will do whatever is necessary

to assist you with your recovery and satisfaction.

(Left) Normal outlet view x-ray. (Right) Abnormal outlet view showing a large bone spur causing impingement on the rotator cuff.

• Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of soft tissues like the rotator cuff tendons. They can show fluid or inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff will be seen.

Treatment

The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.

Nonsurgical Treatment

In most cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.

Rest. Your doctor may suggest rest and activity modification, such as avoiding overhead activities.

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling.

Physical therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.

Once your pain is improving, your therapist can start you on a strengthening program for the rotator cuff muscles.

Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.

may relieve painful symptoms.

Surgical Treatment

When nonsurgical treatment does not relieve pain, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open surgical technique. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.

Rehabilitation. After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing. As soon as your comfort allows, your doctor will remove the sling to begin exercise and use of the arm.

Your doctor will provide a rehabilitation program based on your needs and the findings at surgery. This will include exercises to regain range of motion of the shoulder and strength of the arm. It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year.