PRINCIPLES OF HYDROTHERAPY

Rehabilitation in a warm-water pool facilitates gain of mobility after shoulder arthroplasty. Rehabilitation with the shoulder submerged or partially submerged in warm water provides a “weightless” environment. This “weightlessness” allows the arm to find the best path to achieve a specific movement. Additionally, a warm-water environment provides comfort and improves proprioception while minimizing pain. Whereas thermal neutrality is obtained with water heated to 34°C, a water temperature of 35°C increases skin comfort while increasing body temperature less than 1°C, thus minimizing the risk of development of a heat-induced inflammatory response.

REHABILITATION PROTOCOL

Rehabilitation starts with choosing the type of postoperative orthosis and its duration of use. This is based largely on the type of arthroplasty performed (unconstrained, fracture, reverse) and the performance of any associated procedures (posterior capsulorrhaphy). Table 43-1 summarizes the types of orthoses used and the duration of their use based on the procedure performed. All patients are instructed in hand, wrist, and elbow mobility exercises on postoperative day 1. Patients undergoing unconstrained shoulder arthroplasty for chronic conditions without performance of an associated posterior capsulorrhaphy are also instructed in pendulum exercises on postoperative day 1. These exercises are performed three to five times per day for approximately 15 minutes each time and are continued throughout the rehabilitative program. The time of initiation of hydrotherapy depends on the type of arthroplasty performed. Table 43-2 summarizes the time that hydrotherapy is instituted based on the procedure performed.

Table 43-1 TYPE OF POSTOPERATIVE ORTHOSIS USED AND DURATION OF USE

Table 43-2 TIME FOR INITIATION OF HYDROTHERAPY