The shoulder joint is the most mobile joint in the body. However, it's also the least stable, making it prone to injury. Surgery is often required to repair broken bones, torn tendons and damaged ligaments in the shoulder, and range of motion complications frequently develop after these procedures.
Elbow Range of Motion
Recovery after shoulder surgery typically requires a period of immobilization in a sling. This can cause stiffness in the elbow and forearm because the arm is not being used. Reduced range of motion in the elbow and forearm can significantly interfere with daily tasks, so active range of motion for the elbow is recommended, starting immediately after surgery.
The sling is removed or released at the elbow, typically three times each day for these exercises. Typically, 10 repetitions of elbow bending and straightening are performed, with the goal of maintaining full elbow motion. Forearm rotation exercises, turning the arm palm-up and palm-down, are performed with the elbow bent at a 90 degree angle held tight to your side.
Shoulder Flexion
Shoulder flexion complications are common after shoulder surgery. This movement involves raising your arm in front of the body and is vital for daily tasks such as putting dishes in the cupboard, washing your hair and getting dressed. Shoulder stretching exercises after surgery increase joint flexibility to improve flexion.
Table slides are performed by resting the forearm on a table and leaning the body forward to slide the arm along the table. This improves flexion with the arm fully supported. This exercise can be progressed to wall slides -- walking fingers up a wall or sliding the palm up the wall to improve forward elevation. An overhead rope pulley with two handles can be used to assist the injured arm with flexion by pulling down with the opposite hand.
Shoulder flexion can also be increased using a broomstick exercise. While lying on your back, grasp the stick at each end as it rests on your hips. With your hands palm-down and slightly more than shoulder-width apart, raise the stick up and overhead, then back down to the hips. Although exercise programs vary, 10 repetitions of each exercise are frequently performed working up to three sets in a row, one to two times each day.
Shoulder Abduction
Shoulder abduction complications are also common after shoulder surgery, particularly with rotator cuff repairs. The rotator cuff muscles stabilize the shoulder joint, keeping the ball of the arm bone in the joint socket as the arm moves. Of the tendons associated with the rotator cuff muscles, the supraspinatus tendon is most commonly injured. This muscle performs shoulder abduction, arm movement out to the side and away from the body.
Pulley exercises utilize the uninjured arm to assist the opposite arm into abduction after surgery. Similar to shoulder flexion exercises, table slides, wall finger walks and cane exercises are performed with the arm out to the side to improve abduction.
External Rotation
External rotation of the shoulder may be limited after surgery on the joint. This movement involves turning your upper arm outward at the shoulder. After many types of shoulder operations, external rotation is restricted for four to six weeks to avoid stretching or tearing the repaired tissues again. This restriction is typical after rotator cuff repairs and procedures to correct anterior shoulder instability, or recurrent dislocations. External rotation places pressure on the front of the joint capsule, which can delay healing or stretch the repair.
External rotation of the shoulder is improved with the help of the uninjured arm. While standing or lying on the back, a cane is held horizontally with one hand at each end. The arm that has been operated on is held tight to the side of the body and the opposite hand slowly pushes the cane across the body to bring the forearm out to the side.
External rotation can also be improved using the doorway stretch. The elbow of the healing arm is bent to 90 degrees and held tight to the side of the body. Standing in an open doorway, the hand of the injured arm is placed against the door frame. The body is slowly turned away from the injured arm, bringing the shoulder into external rotation. Stretches are typically held for 20 to 30 seconds and repeated three times in a row, once or twice daily.
Internal Rotation
Limited internal rotation -- rotating the arm in toward the body or reaching behind the back -- is a common complication after shoulder surgery. This motion is needed for putting on a bra, tucking a shirt into the back of your pants or scratching your back. The sleeper stretch is often used to increase internal rotation. The patient lies on the affected side with the injured arm extended outward, perpendicular to the body. With the elbow bent to 90 degrees, the opposite hand slowly applies pressure on the back of the forearm, rotating the arm down toward the table.
Internal rotation can also be increased with the towel stretch. Holding a towel by one end, the unaffected arm reaches up and over the same-side shoulder. The affected arm reaches behind the back to grab the opposite end of the towel. The upper end of the towel is slowly raised toward the ceiling, pulling the affected arm up higher on the back. Stretches are typically held for 20 to 30 seconds and repeated three times in a row, once or twice each day.
