Shoulder instabilities are either congenital or acquired through injury. They represent a painful restriction of function and damage the anatomical structures in the long term. In order to avoid consequential damage, the shoulder is surgically stabilized at an early stage. Targeted rehabilitation is required to restore optimal shoulder function after surgery. The following is a guide for the various phases of recovery.
Aftercare
Every injury, every intervention in our body, heals according to a certain pattern – the wound healing phases. In each phase, something different is in the foreground, which is the focus of the follow-up treatment and every physiotherapeutic intervention. For a better understanding of what is going on in your shoulder, each phase is briefly described – what happens, what are the goals, what can and should be done, what is better avoided.
Wound healing is initiated with the inflammatory phase, day 0 to about day 5. Tissue has been destroyed, cells are damaged and cannot do their job fast enough – debris accumulates, tissue fluid sinks and the typical signs of inflammation (swelling, redness, warmth, pain, impaired function) occur. Helper cells close the wound with a quickly created temporary tissue.
The focus here is on protecting, cooling and elevating the arm. Passive mobilization is performed at an early stage, depending on the doctor’s instructions and the extent of pain. The arm is immobilized for the first weeks with a bandage and splint.
Daily lymphatic drainage is performed in physiotherapy to remove swelling and cell debris. In the second phase, around day 5-21, the focus is on the formation of new tissue. The signs of inflammation decrease and the body produces new healthy tissue.
Here it is crucial to give the new fibers what they are needed for. By taking care of them, they can stick together and become intertwined. In order to avoid this, the shoulder must be regularly moved passively and actively in its physiological sense, and stimuli must be given in the direction of the tensile stress (controlled stretching).
More and more active movement is allowed, controlled stretching and isometric strengthening exercises. Large loads should still be avoided, as the new fibers and are weak and unstable and should not be destroyed immediately. Muscles can already be strengthened isometrically to the appropriate degree.
In this way the fibers of the new tissue are optimally aligned for their later function. Nevertheless, it is important to exercise caution and not to put too much strain on the tissue yet. The last and longest phase in wound healing is the consolidation phase.
This is where the new tissue is strengthened and stabilized. Complete healing can take from 21 to 360 days. The tissue becomes more resilient, more stable.
This is where you have to become active. Active movement, setting stimuli, strengthening, stretching to return to old or improved function and stability. These goals are achieved by means of the so-called MTT (Medical Training Therapy). Individually adapted exercises, with the help of equipment, are carried out under the supervision of trained therapists and doctors. The musculature around the shoulder blade, which is crucial for stability, movement and function, must be strengthened, coordination and fine tuning of the interacting muscles must be trained and stretching exercises for flexibility and full range of motion must be performed.
