The surgical intervention in the shoulder joint is subject to a defined follow-up treatment. The aim is to stabilize and mobilize the total endoprosthesis of the shoulder to such an extent that everyday movements and sports activities are possible again. The recovery consists of three phases of wound healing, which are described below with their contents.
A targeted muscle building program, also on machines, is finally carried out in the last healing phase of the follow-up treatment. This therapy is called medical training therapy (MTT). You will find comprehensive information on this in the article: Shoulder TEP. You will find comprehensive information on this in the article: Shoulder TEP.
Aftercare
The inflammatory phase, which extends from 0-5 days, is divided into 2 phases: In the vascular phase there is an accumulation of leukocytes and macrophages in the tissue. Leukocytes are part of the immune system and macrophages have the task of recycling waste in the cell. The cells in the tissue begin to damage the vascular system, which causes oxygen-rich blood to enter the tissue and increase the PH level, thus triggering the stimulus for further wound healing.
Macrophages are responsible for the division of fibroblasts into myofibroblasts. These are necessary for the new formation of cells. Likewise, the collagen synthesis for type 3 collagen begins, which is only found in the inflammatory phase.
Collagen type 3 is necessary for wound closure. In these first hours of wound healing, there is no specific therapy, only thrombosis prophylaxis and circulation stimulating measures. In the cellular phase, myofibroblasts are still formed.
Type 3 collagen continues to close the wound. The tissue is still only slightly resilient. Many sensitive nociceptors are found at the site of the injury.
These are particularly sensitive, which helps to avoid overloading the tissue. Therefore, especially in this phase, the joint should be adapted to the pain and moved in a tension-free area in order to avoid overloading the tissue. The patient may take his arm out of the splint and perform pendulum movements.
Movement of the surrounding joints including the shoulder blade is possible immediately. If increased pain should occur despite appropriate therapy, this article may be of interest to you: Shoulder TEP Pain
- Vascular phase (first 48h)
- Cellular phase (day 2-5)
>Proliferation phase (day 6-21). The actual inflammation should be complete, the number of leukocytes, macrophages and lymphocytes is steadily decreasing.
From day 14 onwards, only myofibroblasts are found in the new tissue. Decisive for further stabilization of the wound in this phase is collagen synthesis and myofibroblast activity. The loading should continue to take place in the pain-free and tension-free area.
Stretching too early and mobilizing too intensively should still be avoided in this phase, as this prolongs the inflammatory phase and can lead to a pain memory. In the therapy, attention should be paid to a damping of the sympathetic nervous system. This can be produced by soft tissue techniques in the BWS area by the therapist or as independent heat therapy by the patient himself.
This achieves a general relaxation to avoid muscular tensions. In this phase, the patient can actively perform the movements in flexion and abduction, depending on the doctor’s instructions. Muscular stabilization exercises of the shoulder blade muscles are also important.
During these exercises, the patient pulls the shoulder blades backwards and downwards in a supine or seated position. The rotator cuff can also be controlled by isometric tension. The patient tenses the corresponding muscles in the sitting or lying position without performing any movement.
(Day 22-360) The fibroblasts multiply and begin to synthesize the basic substance, thus improving the elasticity of the tissue. The newly formed collagen becomes stronger and more organized. The collagen fibres become thicker and more resilient and type 3 is slowly transformed into type 1.
Myofibroblasts are no longer needed and disappear from the tissue. Depending on the doctor’s statement, the movement may be performed in a final stage and slowly supplemented with weights. Exercises on the pulley are particularly suitable for this.
In particular, the exercises should be performed with the patient pulling his arms down.Until the 120th day, collagen synthesis remains high and on about the 150th day 85% of the collagen type 3 has been converted into collagen type 1. The number of fibroblasts decreases steadily. In this phase of therapy, the load can be increased after consultation with the doctor.
Devices such as the rowing machine can be used, in which the arms are pulled past the side of the body and the shoulder blades are pulled together. The dip machine strengthens the trapezius, and the butterfly can be slowly incorporated with the elbows bent. The bicep machine or training with dumbbells to strengthen the bicep is also possible.
It is important that the weights are set very low from the beginning. Exercises can be performed on the pulley from top to bottom, or a simulated exercise of rowing. If the mobility could be improved and the arms can be lifted upwards without any problems, the lat pull can be included in the training therapy.
Exercises for the rotator cuff can be performed using the pulley, whereby the release of movement must be confirmed by the doctor. Further exercises can be found in the article Physiotherapy shoulder TEP.
