Post Operative Rehabilitation
Rehabilitation guidelines are just that: Guidelines. Not everyone will rehabilitate in the same way. Indeed, there are people who take a lot longer to rehabilitate following surgery, while other people take far less time to rehabilitate following surgery. Guidelines are a rough estimate for all patients as to how long they should expect to be immobilised or stiff and sore.
Some terms used in the paragraphs below:
Active – under the power of the muscles around the operated joint
Passive – not under the power of the muscles around the operated joint, muscles in the opposite limb or sometimes weights or pulleys are used to move the joint. Passive movements are used to keep the joint moving while resting the muscles or tendons that have been repaired.
Range of Motion – the arc of movement allowed by a joint
It is essential in most circumstances that hands are mobilised following fracture surgery. The soft tissues adjacent bone and joints will often scar to one another following surgery and consequently we like patients to mobilise the digits to minimise the scar formation between layers of soft tissue (i.e. tendon and bone). After most hand fracture operations, patients will have a plaster on their hand overnight. The following morning, they will see a hand therapist and have the plaster removed. The wound and swelling will be checked and the fingers will be put through an active range of motion.
It would be very unusual for a hand to be completely immobilised following surgery. Usually we try to make things stable enough to allow early active range of movement. There are exceptions however. Where we are worried about stability (very unstable broken bones) or very unstable joints or tendon repairs we will sometimes immobilise the joint. It is essentially a trade off between having the structure fail (pull away or crush down) and developing stiffness in the joint or structure.
Most commonly following wrist fractures a plaster will be applied overnight following the surgery to allow for swelling. The morning following surgery, the plaster will be removed and a custom moulded plastic splint will be applied and range of movement will commence. In rare circumstances (major joint dislocations) we will need to place small pins across the joints of the wrist thus requiring complete immobilisation of the wrist joint.
Shoulder surgery usually involves a period of sling wearing. If the surgery only requires shaving a bit of bone off such as the acromioclavicular joint or a spur off the acromion, usually the shoulder will be in a sling for one to two weeks as comfort allows. In the circumstance where a joint has been replaced, the rotator cuff tendons have been repaired or the joint has been stabilised (labral repair), the shoulder will be in a sling for six weeks and only gentle passive movements allowed. At the six week mark the shoulder is usually allowed to bear 2kg of weight and gradual increase in range of movement. Usually at around three months, all movements are allowed but the joint will often be stiff and sore.
For a comprehensive guide to shoulder rehabilitation, please see my colleague’s webpage.