After a prosthesis has been inserted, first the postoperative and later the rehabilitative mobilization and restoration of joint function takes place. This is usually done by physiotherapists, but can also be done by occupational therapists. Early mobilization takes place directly one or two days postoperatively and over the entire inpatient stay.
(about 10 days). The focus is on mobilizing, active and passive movement exercises and measures to promote wound healing. During the subsequent rehabilitation (3-4 weeks), work is then continued on restoring function – part of the physiotherapy is strengthening, mobilization and coordination.
Manual therapy
After a shoulder TEP has been inserted, exercise therapy must be started immediately to avoid sticking of the capsule and long-term complaints. The first treatment consists of active and passive movement exercises in the pain-free area, taking into account the contraindicated directions of movement. Depending on how the TEP has been installed, it must be directed to the contra-indicated scheme of roll-slide behavior.
Until the manual therapy is actually carried out, the first wound healing phase is complete, since at the beginning only careful mobilization is required. At the latest from the consolidation phase (from day 21 onwards), joint mobility can be supported with manual therapeutic techniques. The sliding movement can be supported by a thrust in the corresponding direction.
The arm is held in a supporting position and the movement should take place directly in the joint. Manual therapy can be performed in all poorly functioning directions of movement. In addition to manual therapy, general stretching, muscle techniques, fascial techniques should also improve the general movement in the shoulder.
Massages – from when and why
Massages can be performed directly after the insertion of a shoulder TEP. The massage stimulates the blood circulation, which in turn stimulates the metabolic process and supports the healing process. The area of the operation scar should be left out.
However, the patient will also find it unpleasant to work directly in this area. It is more pleasant to loosen the shoulder and neck muscles. In most cases, a shoulder TEP is used because too much of the bone structures have been destroyed by a serious fall on the shoulder or because the arthrosis has become too severe due to many years of wear.
In the former case, a fall causes a protective tension that would prevent physiological movement, since the tone will be very high, especially in the trapezius muscle. In addition, pain and possibly radiations into the arms also occur in this area. With the second problem, the tonus in the shoulder and neck area is also greatly increased due to a long compensation period by pulling the shoulder up in order to raise the arm a little further.
A massage in this area also helps to improve the pain. For both problems there is also an increased tonus in the entire back area, because by compensating by lifting the shoulder around the arm, more tonus comes to the shoulder blade area and BWS and compensatory more tension on the lumbar spine. The biceps muscle can also be problematic due to irritation of the tendon insertion or increased bending position to relieve the arm.
A massage can also be performed carefully here. In general, care must be taken to ensure that the patient is well positioned. If he cannot lie down, he should be treated in a sitting position, as further tensing due to fear would be counterproductive.
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