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Neer protocol

The Neer protocol for postoperative Total shoulder arthroplasty rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing.
Total shoulder arthroplasty (TSA) is a standard operative treatment for a variety of disorders of the glenohumeral joint. Patients, who have continued shoulder pain and loss of function in the presence of advanced joint pathology, despite conservative management, are often managed by undergoing a TSA. The overall outcomes that are reported after surgical intervention are quite good and appear to be primarily determined by the underlying pathology and the tissue quality of the rotator cuff. 

Pendulam

Pendulum: Bend at your waist and support your upper body with your non-affected hand, on a table as shown. Move your affected arm in a circular motion, about one foot in diameter, 10 times clockwise and counterclockwise. Perform 3-5 times daily

Forward Elevation: Supine
Forward Elevation: Supine

Forward Elevation: Supine

Lying on your back, hold the wrist of the operated arm with the good hand and, using the power of the good hand, raise the operated arm up and over your head, then gently lower to the bed always using the power of the opposite arm to move the affected arm. Work up to 3 sets of 5 repetitions.


Forward Elevation: Standing
Forward Elevation: Standing

Forward Elevation: Standing

Standing about one foot from a wall, place a paper towel between the affected hand and the wall to decrease friction, then, using the opposite hand, slide the affected hand as high as possible.

Hold the stretch for 5 seconds. Work up to 3 sets of 5 repetitions.


Assisted External Rotation
Assisted Shoulder External Rotation

Assisted Shoulder External Rotation

Lying on your back with elbows bent 90 degrees, gently push the operated hand outward until your feel tightness, using a stick powered by the opposite hand. Be sure to keep the operated elbow at your side as the shoulder rotates the forearm outwards. Hold the stretch for 5 seconds, relax. Work up to 3 sets of 5 repetitions.


Internal Rotation Standing
Shoulder Internal Rotation Standing

Shoulder Internal Rotation

Standing, grasp the affected wrist with the good hand behind you, gently push the affected arm back away from your body, then push the affected hand up the back as far as possible. Hold the stretch for 5 seconds, relax. Work up to 3 sets of 5 repetitions.

Adduction
Shoulder adduction

Shoulder adduction 

Place the affected hand on the opposite shoulder. Using the power of the opposite hand, pull the affected elbow across your body towards the opposite shoulder as far as is possible. Hold the stretch for 5 seconds. Work up to 3 sets of 5 repetitions.

Extension
Shoulder Extension

Shoulder Extension 

With the thera-band around a door knob and your elbow bent 90 degrees, hold the band with the affected hand and pull backwards as far as possible and hold for 5 seconds, then rest.Work up to 3 sets of 10 repetitions.


External Rotation
Shoulder External Rotation

Shoulder External Rotation 

With the theraband around both wrists and elbows bent 90 degrees, pull the arms away from your body and hold for 5 seconds, then rest. Work up to 3 sets of 10 repetitions.

Shoulder Internal Rotation
Shoulder Internal Rotation

Shoulder Internal Rotation 

Place the theraband around a door knob, use the affected hand to pull the band towards your waist, and hold for 5 seconds. Work up to 3 sets of 5 repetitions.