Copeland Surface Replacement Arthroplasty of the Shoulder

This operative procedure is performed in cases of severe Osteo or Rheumatoid arthritis where pain is the predominant feature.

The hemi arthroplasty is the usual method of choice. Early mobilisation is encouraged.

As subscapularis is released and reattached to the anatomical neck of humerus at the end of the procedure, there should be no resisted internal rotation for the first three
weeks and care should be taken with the range of external rotation.

Pre op:

Patient assessment
Patient’s Constant score recorded
Information given

Post op: Day 1

Mastersling with body belt fitted in theatre
Cryocuff to reduce inflammation
Finger, wrist and radio ulnar movements
Active elbow flexion and extension
Shoulder girdle exercises and postural awareness

Day 2 – Day 3-5 (Discharge)

Body belt removed
Axillary hygiene taught
Continue using cryocuff
Exercises continue as above
Hand gripping exercise
Pendular exercises
Passive flexion/extension in scapular plane in supine
Continue with shoulder girdle exercises, postural awareness and include scapular setting.

Discharge (Day 3-5) to 3 Weeks

Remove sling when comfortable
Pendular exercises continued
Isometric strengthening exercises of all muscle groups (except IR)
Begin passive abduction (maintain shoulder in IR)
Begin passive external rotation to neutral only.

Begin active assisted flexion in supine and progress to sitting position as soon as the patient is able. Progress to active when possible.
Encourage relaxation and breathing control
Hydrotherapy may begin if available

3 Weeks – 6 Weeks

Encourage the patient to actively move into all ranges. Gentle assisted stretching exercise to increase range - do not force inner range ER
Add isometric IR – sub maximally and only if pain free
Commence isometric theraband exercises - resistance dependent on individual
N.B. Take care with IR
Progress to isotonic strengthening
Encourage proprioceptive exercises-weight and non weight bearing

6 Weeks

Progress strengthening and include anterior deltoid exercises
Continue to regularly stretch the joint to end of its available range
Can begin breaststroke if pain and range of movement allows
How well the patient progresses and the outcome will depend on the condition of the joint and soft tissues preoperatively. A better outcome is expected with patients whose joint is replaced for primary OA. Improvement continues for 18 months to 2 years and where possible the patient should not be discharged or should continue exercising until their maximum potential has been reached. The protocol outlined applies to patients with an intact rotator cuff. If a rotator cuff repair has been carried out in addition to the above procedure, the therapist should adhere to the strengthening protocol for the repair.

Return to Functional Activities

These are approximate and may differ depending upon each patient’s individual achievements. However, they should be seen as the earliest that these activities may commence.
Driving After 4 weeks
Swimming
Breaststroke 6 weeks,
Freestyle 3 months
Golf 3 months
Lifting Light lifting can begin at 3 weeks. Avoid lifting heavy items for 6 months.
Return to work - Dependent upon the patient’s occupation:
Those with sedentary jobs may return at 6 weeks.
Manual workers or those whose occupations demand excessive shoulder use should be guided by the surgeon.