After the surgery, the patient's shoulder immobilized to help the healing process and prevent possible discomfort. Physiotherapy aims at improving deformity, to facilitate effortless motion of the shoulder.
Transcutaneous electrical nerve stimulation (TENS):
Transcutaneous electrical nerve stimulation provides pain relief, which may be caused after performing stretching exercises.
Ultrasound is very effective in breaking adhesions.
Thermotherapy is used for relaxation of the muscles before performing the exercise program.
Physiotherapy, consisting of passive and active ROM exercises, beginning after 6 weeks. Gradual relaxed passive mobilization of the shoulder and scapula are done to improve the range of motion and flexibility of the shoulder. Early mobilization of the scapula and shoulder including movements of abduction and elevation.
Strengthening exercises of all the groups of muscles strengthen the weakened muscles.. Strengthening of the shoulder girdle muscles by isometric and isotonic exercises like shoulder shrugs, shoulder rotation, push up, arm support, forearm support, bridging, etc.
Stretching exercise for Upper trapezius muscle:
The child sits in a chair. Place her right hand below her buttocks. The therapist holds the child's scapula by grasping the acromion and lateral border of the scapula. The child then performs neck flexion and neck rotation towards the left side. Then the child places her left hand below her buttocks. The therapist holds the child's scapula by grasping the acromion and lateral border of the scapula. The child then performs neck flexion and neck rotation towards the right side. The child maintains the neck in these positions for 10 seconds during stretching.
Stretching exercises for Levator scapulae:
The child lies in a prone position, with her head rotated to the opposite right side. The child then holds her head and pulls it in flexion with her left hand and abducted her right shoulder as much as possible, without elevating the scapula. The therapist restricts the scapular elevation by grasping the scapula.
The child is in a supine position. The therapist grasps the child's acromion and lateral border of the scapula. The child then flexes her right shoulder with the elbow to 90°. The child uses her left hand to hold her right elbow and then pulls her elbow from the right side to the left side, as far as possible.
Protraction exercise scapula:
The child lies in a supine position. When her right shoulder in 90° flexion and her elbow fully extended. The child then extends her right elbow with maximal force in the forward direction. The therapist grasps the child's scapula by holding the acromion to prevent the scapular elevation and trunk rotation.
Posterior tilt exercise for scapula:
The child is lying in a prone position, with the shoulder abducted to 130– 145°, humerus overhead, and forearm in a neutral position. The child then places the left hand under her forehead and lies slightly on the forehead with the dorsum of her hand. While she lifts her right arm, with her elbow extended, the therapist restricts scapular elevation by grasping the superior angle of the scapula.