March 15. March 18 – Just back from the Doc and starting the next 6-week phase which is Physical Therapy to increase flexibility, but not strengthening. Doc’s two simple rules: 1) keep hand where you can see it 2) don’t lift anything heavier than 12 oz can of pop.
The latter will be hard. The mode of failure will be silent, there will be no pain. The failure will be degradation of the developing new cartilage from the micro-fracture treatment, which will eventually flake, slough off, and I’ll be a candidate for shoulder replacement. (Might have been nice to know this before now as I have progressively begun to cheat, both in and out of the sling.)
Week of March 22: First visit to Physical Therapy Monday 7am. This guy measures rotation from a different zero point than my chair uses. Rather than getting 60, he measures me at 25. So machine – 35. I managed to do mt chairs 160/60 this AM, and am now trying to do wider rotation w/o elevation (faster cycle time). I got to 130/80. Going high and wide was harder than just going wide at elevation 30. I’d need to push the chair to 160/95 to match the Doc’s goals with the PT’s measurement scheme. The PT also gave me non-chair way to do the same exercises. I’ll go to PT Mon & Wed for next 6 weeks.
Tues 23rd Pretty stiff and sore this AM after pushing yesterday. I’ve relapsed. Just did 115/80 by building up from 80/65. The chair goes away today or tomorrow, unless the Doc gives a reprieve. I got the reprieve to March 31 and I’m regretting pushing because the relapse Tues aft is worse.
Wed 24th This AM my PT encouraged that 60 to 80 was a big jump, and that elevation was more important now than rotation. We agreed I’d attempt to get back to 160/60 and then use the next week of CPM machine to move from 60 upward, perhaps 4 degrees for each of 5 days. This AM I got back to 160/60.
Week of March 29: PT this AM helped me not relapse in the chair. I’ve regained the desired elevation, and intend to expand the rotation slowly this week until the chair goes away. Small personal victory, I can now carry a small bar of soap in my left hand to wash my right arm pit.
Criteria for Progression to Phase 2
- At least 6 weeks of recovery has elapsed
- Painless passive ROM to (see data here)
- 140° of forward flexion
- 40° of external rotation
- 60-80° of abduction (swing arm out from side) (not sure if I can do this, its not part of the machine)
- 140° of forward flexion – progress to 160° (see graphs below)
- 40° of external rotation – progress to 60°
- 60-80° of abduction – progress to 90°
- Continue with passive ROM exercises to achieve above goals. (looks like I can get there in one day)
- Begin active-assisted ROM exercises for the above goals.
- Progress to active ROM exercises as tolerated after full motion achieved with active-assisted
- Light passive stretching at end ROMs.
- No strengthening/resisted motions of the shoulder until 12 weeks after surgery.
- During phase 2, no Active Range of Motion (AROM) exercises for patients with massive tears.
- Discontinuation of sling or abduction orthosis.
- Use for comfort only.
- NSAIDs for patients with persistent discomfort following surgery.
- Therapeutic modalities
- Ice, ultrasound, HVGS.
- Moist heat before therapy, ice at end of session.
NOTE: Blue data is first 6 weeks, red data is 2nd 6 weeks on new regime
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