My first appointment was my evaluation which I went to on a Thursday night, POD 43. I waited a few minutes in the waiting room before I was seen. Once I went in the therapist, James sat me down on an exam table and we had a chat and he evaluated my shoulder. He checked my range of motion and asked exactly what I had done. There was some confusion because it seems that Dr. Hershon wrote that I had a posterior repair on my prescription but, as far as I knew, I had a Bankart Repair which is an anterior repair and I always dislocated anteriorly. James wanted to know for sure because it was going to make a difference as to how much they were going to push my shoulder for certain ranges of motion. To be certain, he asked me to call the doctor's office and get the operative report. The report would tell us exactly what had been done. He told me that if I had had a Bankart Repair we would not push the external rotation beyond 75 or 80 degrees because it puts pressure on the front of the labrum, which is exactly what I had repaired. He wanted to know but it was not going to make a difference for this visit. He also told me that, even though we would not recover the full 90 degrees of external rotation, I would not notice it in day to day life.
After we did the evaluation he told me what we were going to do while I was there and what he wanted me to do for the day and what I would be doing for ,at least, the next two visits. They started me off with about 20 minutes worth of heat , then they had me work on the pulleys for 30 reps, which is similar to the assisted front flexion I'd been doing at home, a set of the pendulum (Codman) exercises and they showed me how to do the wand exercise for external rotation.
They had me lay on a table to do the wand exercise. I laid on my back and put the head of a golf club in my left hand and with my elbow at my side and with my forearm bent at 90 degrees. I then took the grip of the club in my right hand and pushed my left arm toward an externally rotated position until I felt resistance and then held it for 5 seconds. I did the three sets of ten was that I was assigned.
After I finished the exercises, James did an ultrasound treatment which he said would help with internal swelling and stiffness and then he stretched me out. He worked on my flexion and external rotation and generally loosening the arm. When he pushed me to my tolerances there was some discomfort but no pain to speak of. The front flexion felt weird. I'm still very guarded but it didn't hurt. After that they sat me down for ice and electrical stimulation. I've had stim many times before and this was the first time I was able to say that it didn't feel like my shoulder was going to come out of the socket when they turned it up high.
Before I left, James told me I should come in three times a week for now since I needed a lot of work on my external rotation and I would need to spend much of my time working on that one motion. He also told me to do my Codman and the front flexion exercises at home twice a day and the wand exercises 4 times a day, 30 reps each. It was a lot of work to do but it was what was needed.
The day after my evaluation I called Dr. Hershon's office and they faxed me the operative report. In spite of what had been written on the prescription, the report indicated that I had a Bankart repair. I brought it to my next appointment and we decided to go with what was written in the report as gospel. I didn't even know such a document would be available to me. If you're planning on going to PT after a surgery you should definitley ask your doctor for this and bring it with you.
My next two appointments were pretty much the same routine as my evaluation. I started with heat, followed by pulleys, Codman, wand exercises then ultrasound, stretching and massage and finally, ice and stim. During my third appointment I was shown how to do the wand exercise to work on my front flexion but that was the only change. The illustration shows the flexion being done standing but I did mine laying down. I think it helps to have gravity on your side. I also found that using the wand seems to help me get over that guarded feeling much more than just using my right hand. Maybe I can sleep with my hands behind my head again soon!
I worked on doing my exercises at home. 4 times a day was a lot to try to do the wand exercises, especially when I was working. After a few days I managed to borrow a yoga mat and a golf club at work which allowed me to spread the sets out through the day. I do have to say that doing the wand exercise for the external rotation as much as I've been doing it has left me sore in my pectoral muscle and I've also felt it in my latissimus dorsi. I also noticed that my shoulder feels better immediately after the PT sessions. I was able to do things without some of the pain and discomfort I had felt before. Little things like turning the wheel on my car was easier, putting dishes on the drain board and I was almost able to get up to the first fret on my guitar this afternoon. Even though I've only been to PT three times I'm noticing improvements.
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