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Aquatic exercise boosts recovery from

Shoulder Surgery And Injury


Shoulder pain is very common and includes a whole spectrum of disorders from rotator cuff impingement, acute tears involving the rotator cuff or labrum, long-term degenerative tears and shoulder joint degenerative conditions.

What are some of the different types of shoulder surgery?

Arthroscopic subacromial decompression (ASAD)

Subacromial impingement occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass beneath the acromion and through the subacromial space. Most cases respond well to conservative treatment of Physiotherapy, modification of activity and non-steroidal anti-inflammatory medications.  Surgical intervention, either through open or arthroscopic approaches may be indicated in patients who fail a 3 to 6 month course of nonsurgical management.

Arthroscopic subacromial decompression (ASAD) aims to give pain relief by removing the inflamed subacromial bursa and shaving the bone on the under-surface of the acromion. This surgery may or may not include the removal of the anterolateral part of the acromioclavicular joint and/or calcification within the tendons. The arthroscopic approach to subacromial decompression provides adequate visualisation and access to the acromial undersurface and its advantages over an open approach include deltoid preservation, decreased blood loss, lower levels of postoperative pain and faster recovery.

Rotator Cuff Repair

Acute rotator cuff tears can occur by falling on an outstretched arm or sudden lifting particularly under load. Degenerative tears can occur as a result of wear and tear as a normal part of the aging process. Surgery is usually considered for acute tears. Depending on the severity of your tear, your surgeon may recommend one of the following procedures:

  1. Open Repair: If your tear is particularly complex or large, your surgeon will likely choose this option to fully detach the shoulder muscle and better see the torn tendon. Bone spurs are usually removed and additional reconstruction may be performed.
  2. Arthroscopic Repair: Using a small camera in your shoulder through a small incision, instruments are used to repair the tear. This method is less invasive and usually means quicker recovery.
  3. Mini-Open Repair: With a 3 to 5 centimetre incision, an arthroscope is used to remove bone spurs and treat damage. After this portion of the procedure, the rotator cuff is repaired via the incision while viewing sutures directly (without a camera).

"Good morning all at Aqua Physio, as you can see, I am enjoying a short holiday in Perranporth, Cornwall. Because of your help I was able to throw a ball for the dog with my bad arm. Sadly, that was unsuccessful and went about six feet. However, to throw at all and not be in agony was amazing. Thank you for what has been the most effective physio I have received since my accident, I am very grateful; not just for the hydro therapy but also the skill, knowledge and care of your team."
 

KM

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A patient working in the pool to rehab from a shoulder fracture

Stabilisation surgery

Instability in the shoulder, usually the result of acute dislocation, can damage the labrum which is a cartilage inside the shoulder joint or the ligaments around the glenohumeral joint.

  1. Labral repair: This procedure is performed to repair a tear to the labrum and is commonly  arthroscopic. In small tears it is sometimes not necessary to repair the tear, but rather to debride which is removing the frayed edges and any loose parts that get caught when your shoulder is moved. A larger tear is repaired using suture anchors and heavy suture to reattach the labrum to the socket.  An open procedure may be necessary if the bone of the socket is involved in the injury.
  2. Capsular shift: A capsular shift involves tightening of the joint capsule, including the ligaments that stabilise the shoulder. This is similar to when a tailor tucks loose fabric by overlapping and sewing the two parts. By tightening the ligaments, they are then able to perform their stabilising function.

Shoulder Replacement Surgery

Depending on the severity of your shoulder tear and degeneration in the glenohumeral joint, you may require shoulder replacement:

  1. Resurfacing Hemiarthroplasty: The cap of your ball joint is with replaced with prosthesis, preserving the remaining bone.
  2. Stemmed Hemiarthroplasty: Only the ball part of your shoulder joint is replaced with a metal ball and stem.
  3. Total Shoulder Replacement: Your entire ball and socket joint will be replaced with metal and plastic respectively.
  4. Reverse Total Shoulder Replacement: The total shouder is replaced, but the ball and socket positions switch.

What are the benefits of hydrotherapy following Shoulder surgery?

There are many benefits for the early use of aquatic Physiotherapy following shoulder surgery. The buoyancy effect allows normal active shoulder movements with reduced muscular activity and less load on the repaired tissues, so active motion can be done earlier and more safely compared with exercise on land. The heat of the water also allows for increased circulation and can be very effective for very painful and guarded shoulders allowing an effective introduction to shoulder rehabilitation.

When can I start hydrotherapy following Shoulder surgery?

Aquatic Physiotherapy is safe and can be commenced within days of surgery once your wounds have healed. Studies comparing Land-based Physiotherapy with combined aquatic and land Physiotherapy have shown significant improved passive flexion at 3 and 6 weeks post-operatively. You will need to check with your surgeon before booking.  

REFERENCES

McClincy M., Rodosky M., (2015). Arthroscopic Subacromial Decompression. Operative Techniques in Orthopaedics 25 (1), p10-14

Brady B., Redfern J., Macdougal G., Williams J. (2008) The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study. Physiotherapy Research International. 13 (3) p 131–199.

Kelly, B., Roskin L., Kirkendall D., Speer K. (2000) Shoulder Muscle Activation During Aquatic and Dry Land Exercises in Nonimpaired Subjects. J Orthop Sports Phys Ther 30 p204-2 10.

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