Standard Post Proximal Humeral Fixation Rehabilitation Protocol:
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Aims:
The aim of the rehabilitation is to protect the are to protect the repair in the early stages and to maximally optimise function in the long-term.
General Points :
• Do not push through pain – remember pain inhibits rotator cuff control
• Do not sacrifice quality of movement for range of movement
• Remember the patho-physiology of the repaired tendon is often degenerative and needs to be considered when progressing rehabilitation.
Immobilisation:
• The patient is to wear a sling for 6 weeks. It can be removed to perform exercises as instructed by the physiotherapist.
Post Operative Instructions:
0-6 weeks:
Sling to be worn.
Hand, Wrist and Elbow exercises.
Pendular exercises.
Encourage optimal Scapulo-Thoracic position.
Active assisted External Rotation to neutral/0o.
Active assisted elevation as comfort allows.
From 6 weeks:
Wean out of sling – light activities only.
Gradually increase External Rotation.
As External Rotation increases gradually increase Elevation Range of movement.
Active assisted exercises
From 8 weeks:
Active assisted progressing to short lever.
Supine and closed kinetic chain if appropriate.
From 10 weeks:
Short lever progressing to Long lever exercises.
No resistance or open chain exercises until 12 weeks
12 weeks onwards:
Isometric exercises in variable starting positions progressing to
Resisted movements through range and strengthening
Functional Milestones and Activity Time Scales:
Driving See general principles of rehabilitation.
Swimming 12 weeks plus.
Golf 12 weeks plus.
