Deltoid Rehabilitation Programme Protocol
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The rotator cuff muscles, which normally stabilise the gleno-humeral joint, may not function. This is usually as a consequence of a large tear of the tendons. This may result in an inability to lift the arm sideways away from the body.

The deltoid, which provides the power to lift the arm, is usually preserved but may not function because of the failure of the rotator cuff muscles to allow the shoulder to pivot around the joint.

The deltoid muscle may be re-trained to compensate for the lack of rotator cuff function.

The following exercise programme should be undertaken 3-5 times per day to strengthen your deltoid muscle. This may improve both the pain and range of movement. The exercise programme must be followed for at least 12 weeks. The supervision of a qualified physiotherapist is always advised.


Exercises:

Supine active assisted:
These exercises involve concentric (shortening of the muscle against resistance) and eccentric (lengthening of the muscle against resistance) deltoid contraction.

Lying on your back with the head supported by a pillow:
Bend your elbow as far as possible.
Raise the arm 90 degrees (until the elbow is pointing upwards).

The other arm may be used for assistance.
Once the arm is at 90 degrees the elbow may be straightened.
Hold the arm in the vertical position.
With the fingers, wrist and elbow straight make slow circular movements.

Move clockwise then counter-clockwise, drawing a circle in the air.
Over a period of weeks the size of the circle drawn may increase.

Move the arm forwards and backwards in line with the leg and body.
Then move the arm side to side across the body, thereby drawing a cross in the air.

As confidence increases a light weight, equivalent to a tin of beans, may be held in the hand and the above steps repeated.

As confidence increases further the lying position can be altered increasing to an inclined to a sitting and then standing position. As the position is changed, return initially to un-weighted exercises before again building up to a light weight.


Resisted exercises:
These exercises work on concentric contraction (shortening of the muscle against resistance).

Make a fist with the effected arm. Place the palm of the other hand over the fist. Push with the fist and palm against each other. Gradually allow the fist to push harder against the palm and the arm will elevate above your head.
Repeat this manoeuvre to re-train the deltoid.


How often and how long?
These exercises should be repeated 10 times per session and the sessions repeated 3 to 5 times per day.
Stop exercising if you feel unwell or if you have pain.
Improvement will typically take 6 to 12 weeks.





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