Surgery Day + 21

Physical therapy:

I met my physical therapist today.  So professional. She has consulted with the surgeon, developed a plan, and, best of all, it fits everything I have read on the subject. It must drive health care professionals crazy as anyone with a computer and access to the internet can be an expert, me included. But the therapy for rTSA is very specific and gentle. You want to be sure your therapist is following the proper guidelines. Even non aggressive movements can result in disaster.

For the first six weeks:

0. Phase I Precautions:
   
• Sling is worn for 3-4 weeks postoperatively and only removed for exercise and bathing
  once able. The use of a sling often may be extended for a total of 6 weeks, if the current
  rTSA procedure is a revision surgery.
  
• While lying supine, the distal humerus / elbow should be supported by a pillow or towel
  roll to avoid shoulder extension. Patients should be advised to “always be able to
  visualize their elbow while lying supine.”
  
• No shoulder AROM.
  
• No lifting of objects with operative extremity.
  
• No supporting of body weight with involved extremity.
  
• Keep incision clean and dry (no soaking/wetting for 2 weeks); No whirlpool, Jacuzzi,
  ocean/lake wading for 4 weeks. 
  

• Joint protection: There is a higher risk of shoulder dislocation following rTSA than a conventional TSA. Shoulder Dislocation Precautions:

• No shoulder motion behind back. (NO combined shoulder adduction, internal rotation, and extension.)
  
• No glenohumeral (GH) extension beyond neutral.
  *Precautions should be implemented for 12 weeks postoperatively unless surgeon specifically advises patient or therapist differently. 
  

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Avoidance of shoulder extension past neutral and the combination of shoulder adduction and internal rotation should be avoided for 12 weeks postoperatively.
Patients with rTSA don’t dislocate with the arm in abduction and external rotation. They typically dislocate with the arm in internal rotation and adduction in conjunction with extension. As such, tucking in a shirt or performing bathroom / persona hygiene with the 
operative arm is an especially dangerous activity particularly in the immediate peri-operative phase.

For the first six weeks: